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Post by mnholdem on Apr 28, 2015 8:38:28 GMT -5
BALANCE SHEET Of LIFE: - What you receive is Credit
- What you give is Debit
- Birth is your Opening Stock
- Death is your Closing Stock
- Your ideas are your Assets
- Your views are your Liabilities
- Your happiness is your Profit
- Your sorrow is your Loss
- Your soul is your Goodwill
- Your heart is your Fixed Assets
- Your duties are your Outstanding Expenses
- Your friendships are your hidden Adjustments
- Your character is your Capital
- Your knowledge is your Investment
- Your patience is your Bank Balance
- Your thinking is your Current Account
- Your behaviour is your Journal Entry
- Bad things you should always Depreciate
- And every good thing you should always Appreciate.
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Post by me on Apr 29, 2015 15:05:20 GMT -5
I'm wondering if anyone else's insurance has changed like mine has. Just about everyone I know personally has gone through this change, but, I'd like to hear from as many people hopefully representing a much wider scope here. Has your health insurance changed where you used to have prescription coverage, but, over the last year or two found yourself paying for medications as well as all healthcare needs (except the exclusions like physicals) through your deductible first before the 80/20 or 90/10 or whatever the split is in your plan actually kicks in?? I'm asthmatic and I take advair. Two years ago it was 70/month copay, no deductible. Last year? almost 300/month going through my deductible first, when that was exhausted, then there was the annual max amount, and THEN the 80/20 kicked in. After looking around and talking to people, I wasn't the only one. This year I went another route to obtain advair and I'm back to about 70/month again (canadian pharmacy). So the question is - I'm wondering how much change is going on in healthcare, specifically, how many of you out there are paying for medications out of pocket until your deductible and annual max is met BEFORE your plan kicks in?And for details, my wife and I are both professionals, have insurance through her work (a big and profitable defense contractor type company - they aren't hurting for profits), have our plan through cigna, don't have medical issues beyond asthma, migraines, and routine stuff. The plan is just a regular plan - nothing exotic. Had some health issues this year, but, the plan was the plan before those issues. thx! Oh, and how this relates to afrezza - costs to consumer. Sano is currently covering the cost by providing a discount card, but, once they roll that back I'm wondering how it will impact the consumer as it relates to coverage and deductibles and annual max amounts?! and no, I'm not making this up, here's some reading on the subject (just a quick google search yields a lot of info on this subject but here's a link anyways) www.dailykos.com/story/2013/10/08/1244896/-ACA-Understanding-the-details-Deducing-the-deductible-something-you-DO-need-to-think-about#Davinci, I am really trying to be nice here, but Savzak's characterization of you a little further up is so right on the money. First, a little about myself. After some time spent falling out of airplanes and crawling through the mud eating bugs, I dove head first into the employee benefit/insurance industry. Over the past 27 years, I've sold hundreds of millions of dollars of employer group health insurance, was the CFO responsible for $2 billion of large group health insurance premiums, ran one dental company and co-founded a second, headed sales for a large Blues plan in their individual and small group marketplace, started an HMO in fugacity's backyard, consulted for large employers on their health insurance programs, served on two state insurance regulatory bodies and founded a prescription benefit company, which I currently run. I am intimately familiar with the ACA and am one of the few individuals who have read the damn thing from cover to cover. I've also filed hundreds of employee benefit plan designs with five different departments of insurance. Given all of this, I think I know a little about health insurance plans. So, your statement above, "almost 300/month going through my deductible first, when that was exhausted, then there was the annual max amount, and THEN the 80/20 kicked in," is a lie (using Savzak's characterization). And here's why: you can mean only one of two things when you state, "annual max amount," and neither definition allows your statement to be true. The first definition, which is correct for the actual terminology you used, means the maximum amount that the insurance company will pay towards your benefits in a policy year. So, if this is what you meant, you're wrong. You don't pay up to the annual max, the insurance company does. Further, most large employers (I'm taking your word that your wife works for a large company) do not have annual maxes, and when they do, they're generally are $1 or $2 million. And further, except for grandfathered plans, the ACA prohibits annual maxes (see my definition above). And even further, since your wife's employer's plan had the plan change you described, that would disqualify them from being grandfathered. Now, I'm going to guess that rather than "annual max amount," you actually meant "annual maximum out-of-pocket (OOP)." This is the max OOP that the member is required to pay during the policy year and/or calendar year. After the OOP max, eligible benefits are paid at 100%. So the order of payment you listed above - deductible, max OOP amount, then coinsurance (80/20) - is wrong...or in the vernacular, is a lie. The insurance company always pays something towards eligible charges before the member meets the max OOP amount - that's what the definitions mean. Now, before you go scrambling around the internet for exceptions, plans sold through the various state/federal marketplace websites may include limited prescription plans that may very well include layered med/Rx deductibles, limitations/restrictions via a formulary or some other such limit, but your wife's employer's plan was not purchased on a state/federal marketplace, so none of this applies. Your wife's plan is required under the ACA to offer the 10 Essential Health Benefits (EHBs), with no annual or lifetime maximums. And because the plan is a deductible/coinsurance plan, the insurance company begins paying after you have met your deductible, and before you've met your OOP max. And just in case you were a little mixed up in your description of your plan and it included a copay prior to or in conjunction with the deductible, my point still stands. It's simply wrong that you have to meet your OOP before coinsurance kicks in. And if you wish to have that discussion regarding MNKD's balance sheet, I'd be happy to do that also. Subtlely Yours, me
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Post by liane on Apr 29, 2015 16:12:09 GMT -5
me,
That was a really good explanation!!
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Post by hankscorpio7 on Apr 29, 2015 16:16:49 GMT -5
Me- tried and almost succeeded. Much better post! Would have been even better without the lying accusations. Thanks for the info. So what are the copayment for the Afrezza competitors?
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Post by jpg on Apr 29, 2015 16:26:36 GMT -5
Me- tried and almost succeeded. Much better post! Would have been even better without the lying accusations. Thanks for the info. So what are the copayment for the Afrezza competitors? Tag team Hank and Davinci?
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Post by me on Apr 29, 2015 18:19:16 GMT -5
Me- tried and almost succeeded. Much better post! Would have been even better without the lying accusations. Thanks for the info. So what are the copayment for the Afrezza competitors? I'll take this as a legitimate question whose answer will further our purposes here on this board (more on this at the end). First, please list the prescriptions which you define as Afrezza competitors. With this list, I'll answer your question for each prescription you list. I would ask only that you also describe why you think each of the prescriptions you list are competitors of Afrezza, and why, specifically, you think the answers to your question will impact the success of Afrezza.
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Deleted
Deleted Member
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Post by Deleted on Apr 29, 2015 18:46:53 GMT -5
Me- tried and almost succeeded. Much better post! Would have been even better without the lying accusations. Thanks for the info. So what are the copayment for the Afrezza competitors? I'll take this as a legitimate question whose answer will further our purposes here on this board (more on this at the end). First, please list the prescriptions which you define as Afrezza competitors. With this list, I'll answer your question for each prescription you list. I would ask only that you also describe why you think each of the prescriptions you list are competitors of Afrezza, and why, specifically, you think the answers to your question will impact the success of Afrezza. Not the OP of the question but interested Humalog/Novalog.. ? For some patients , co payment matters..i have heard from a few docs , patients prefer drugs with low payments ,( for ex :If Afrezza was 100% covered .. then no one would have second thoughts ) but then I know Afrezza is a class of its own even though its compared with the other two and we should go by the perception tthat exists now... ..which should change in the near future...and it will probably be the first line of drug after every one knows of the benefits...
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Post by hankscorpio7 on Apr 30, 2015 15:22:21 GMT -5
Me- tried and almost succeeded. Much better post! Would have been even better without the lying accusations. Thanks for the info. So what are the copayment for the Afrezza competitors? I'll take this as a legitimate question whose answer will further our purposes here on this board (more on this at the end). First, please list the prescriptions which you define as Afrezza competitors. With this list, I'll answer your question for each prescription you list. I would ask only that you also describe why you think each of the prescriptions you list are competitors of Afrezza, and why, specifically, you think the answers to your question will impact the success of Afrezza. Hey me- thanks for taking my question. Tzd, metformin, the pens. Why? To gauge what cost it would be to a new patient to switch. Some are managing their diabetes and would be resistant to change- especially if over few hundred dollars a year difference. If people are starting to use less basal or none, cost basis of that could be useful to decrease Afrezza cost. I am not arguing anything is superior. If too busy, no worries. Also, what percent reimbursement rates are those drugs getting? Insurance doesn't pay retail correct? I am not being superfluous, you seem like a numbers guy and have these numbers around.
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Post by liane on Apr 30, 2015 16:57:23 GMT -5
I'm locking the thread and have removed some of the superfluous posts. I tried to leave this open as long as possible as there were actually some good posts, but it keeps degenerating.
Those that have posted good stuff - feel free to start a new thread. Hopefully there will be no further YMB style antics.
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