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Post by sellhighdrinklow on Feb 12, 2018 22:57:15 GMT -5
I was previously insured by Anthem BC up until, 12/31/17 when they discontinued coverage in California. In my research of which healthcare insurance company to sign up for, for 2018, I called Blue Shield and was told Afrezza IS covered but needs prior authorization. So, I signed up.
When late January rolled around and it was close to needing to re-up my Afrezza delivery from Mankind's designated pharmacy, the pharmacy called me. I was surprised. I told the pharmacy representative, "Wow, I was about to call you, AB Cross no longer covers me and I'm now w Blue Shield of CA, just so you know". The pharmacy's reply was, "No problem sir, we just punch your name into our computer and your current insurance comes up." My deductible increased from $15 to $20. Smooth, no worries!!
Fast forward to a few days ago when I opened a letter from Blue Shield, telling me they sent my Afrezza as a courtesy, blah, blah blah, not a preferred tier (or similar) and we "might" cover w prior authorization....
Castagna's tweet has me concerned. If a move from 6.7 A1C to 5.7 (latest) and fewer hypos isn't approved, I'll flip my lid.
I'll update when I hear back.
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Post by mbracket123 on Feb 12, 2018 23:59:59 GMT -5
Has Anyone gotten to CBS 60 Minutes with all the drama involved here. Everything from Shkreli, to Al's life and legacy, to the PBMs payola, to the fact that this is probably one of the top life changing treatments to come along in the last 20 years. Its made for TV. Someone must have some in's to get this to the desk there.
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Post by peppy on Feb 13, 2018 2:31:47 GMT -5
Has Anyone gotten to CBS 60 Minutes with all the drama involved here. Everything from Shkreli, to Al's life and legacy, to the PBMs payola, to the fact that this is probably one of the top life changing treatments to come along in the last 20 years. Its made for TV. Someone must have some in's to get this to the desk there. Big Pharma is the only advertising CBS (news) has left. the old, don't bite the hand that feeds you....
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Post by careful2invest on Feb 13, 2018 2:48:37 GMT -5
Has Anyone gotten to CBS 60 Minutes with all the drama involved here. Everything from Shkreli, to Al's life and legacy, to the PBMs payola, to the fact that this is probably one of the top life changing treatments to come along in the last 20 years. Its made for TV. Someone must have some in's to get this to the desk there. Big Pharma is the only advertising CBS (news) has left. the old, don't bite the hand that feeds you.... The 💩 is about to hit the fan. FBI probes exposing corruption... News of corruption at Aetna is just the beginning of more corruption with other carriers to be exposed... We need a cleansing, across the board! Looks like we're about to get one! GLTA!!
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Post by mnholdem on Feb 13, 2018 5:07:37 GMT -5
During his State of the Union address, President Trump stated that dealing with high drug prices in the U.S. will be his Number 1 priority in the coming year. Whether Congress changes current laws or not is a different matter, since a lot of cash from pharmaceutical companies went into election campaigns on both sides of the aisle.
Regulatory changes are already in the works at the FDA but, until something is done about the broken system of medical coverage (broken from the patients' standpoint, that is) new and promising treatments will continue to be thrown into the lions den, IMO.
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Post by hellodolly on Feb 13, 2018 6:15:40 GMT -5
twitter.com/castagna2011?lang=en
Mike Castagna @castagna2011 · 11h11 hours ago
"You wonder why AETNA made over $4B in cash flow last year. Easy when you deny care and bill the employer fees not based on any outcomes. United and Blue Shield of CA are even worse. Wait until other medical directors have to put their neck on the line."
This is pretty strong language considering how important third party payers are for Afrezza's future success. Or maybe there is another (better?) plan in the works?
I believe Mike comment was about edition.cnn.com/2018/02/11/health/aetna-california-investigation/index.htmlCNN Exclusive: California launches investigation following stunning admission by Aetna medical director Exactly! He was addressing what could very well be systemic.
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Post by mnkdfann on Feb 13, 2018 9:24:28 GMT -5
During his State of the Union address, President Trump stated that dealing with high drug prices in the U.S. will be his Number 1 priority in the coming year. Whether Congress changes current laws or not is a different matter, since a lot of cash from pharmaceutical companies went into election campaigns on both sides of the aisle. So much for reforming immigration and the big, beautiful, wall. But seriously, according to the transcript, he said: "One of my greatest priorities is to reduce the price of prescription drugs. (Applause.) In many other countries, these drugs cost far less than what we pay in the United States. And it’s very, very unfair. That is why I have directed my administration to make fixing the injustice of high drug prices one of my top priorities for the year. (Applause.)" www.whitehouse.gov/briefings-statements/remarks-president-trump-state-union-address/So drug pricing is a great priority, but far from Number 1. (It wasn't his first promise in the speech, it wasn't the last, it was one of many buried in a long promise list, and he just gave the topic about 4 or 5 short sentences.) www.latimes.com/business/lazarus/la-fi-lazarus-sotu-trump-drug-prices-20180201-story.htmlEXCERPT from above: Trump undoubtedly knows this issue plays well with focus groups on both sides of the ideological fence. But, after a year in office, he has made no effort to tackle runaway drug prices. If anything, he's gone completely in the other direction by appointing as Health and Human Services secretary a former drug industry executive who oversaw huge increases in his company's prices, including a doubling of insulin prices.In fact, Alex Azar was asked during his confirmation hearing if, while running U.S. operations for Indianapolis drugmaker Eli Lilly & Co., he lowered the price of a single drug. "I don't know that there is any drug price of a branded product that has ever gone down from any company on any drug in the United States," he replied, suggesting such an idea runs counter to every capitalistic principle this country stands for (#MAGA).
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Post by mnkdfann on Feb 13, 2018 9:34:05 GMT -5
First reviews are in of Trump's budget plans to reduce drug prices. khn.org/news/trumps-budget-proposal-swings-at-drug-prices-with-a-glancing-blow/James Love, director of the nonprofit Knowledge Ecology International, said Trump’s proposals are not “insightful or original” and ... said it “could have been written by PhRMA,” the powerful D.C. lobbying firm for pharmaceutical manufacturers. PhRMA released a statement late Monday applauding the provision to pass on rebates to Medicare beneficiaries but also raising concerns about other elements of the budget proposal, saying they would “limit access to innovative medicines.” thehill.com/regulation/healthcare/373530-trump-fires-first-salvo-on-drug-pricesDavid Mitchell, founder of the advocacy group Patients for Affordable Drugs, said the proposals are “tinkering around the edges” of the issue but do not get at the “root cause, which is the drug companies charge too much money.” The proposals in Trump’s budget include capping out-of-pocket drug costs for Medicare enrollees, allowing up to five states to join together to negotiate drug prices in Medicaid, limiting the growth rate of certain Medicare drug payments to inflation and requiring insurers to pass drug discounts on to consumers. Notably, the proposals do not include more sweeping changes that Trump has supported in the past, such as Medicare negotiating drug prices or allowing the importation of drugs from abroad. “The administration is taking great pains to avoid really challenging pharma,” said Peter Maybarduk, who advocates for lowering drug prices at the group Public Citizen. Rachel Sachs, a professor at Washington University in St. Louis who does work on drug pricing issues, said the proposals would provide relief for some Medicare and Medicaid beneficiaries, but do almost nothing for the majority of Americans who get insurance through their jobs and face high drug costs. Sachs said the proposals did not seem to match Trump’s rhetoric about drug companies. “This is a very pharma-friendly set of proposals in many ways,” she said.
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Post by peppy on Feb 13, 2018 9:42:08 GMT -5
my understanding is legislation has been written by lobbyists for years.
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Post by celo on Feb 13, 2018 10:03:02 GMT -5
Maybe Dave showed Mike how uneven the playing field really is. Maybe Dave described to Mike some of the many things Eli Lilly does to maintain market share with insurance companies. Maybe Dave told Mike your superior product will remain niche, due to the way big Pharma and big insurance are structured. Sounds from Mike's tweets he is pissed. I would be really pissed, too.
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Post by kc on Feb 13, 2018 10:29:28 GMT -5
Maybe Dave showed Mike how uneven the playing field really is. Maybe Dave described to Mike some of the many things Eli Lilly does to maintain market share with insurance companies. Maybe Dave told Mike your superior product will remain niche, due to the way big Pharma and big insurance are structured. Sounds from Mike's tweets he is pissed. I would be really pissed, too. You must interpret things differently than most of us I don’t see Mike being pissed. I see him working to remove obstacles one at a time and it takes a lot of time to remove each one.
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Post by gamblerjag on Feb 13, 2018 10:46:10 GMT -5
Maybe Dave showed Mike how uneven the playing field really is. Maybe Dave described to Mike some of the many things Eli Lilly does to maintain market share with insurance companies. Maybe Dave told Mike your superior product will remain niche, due to the way big Pharma and big insurance are structured. Sounds from Mike's tweets he is pissed. I would be really pissed, too. You must interpret things differently than most of us I don’t see Mike being pissed. I see him working to remove obstacles one at a time and it takes a lot of time to remove each one. agree. Just the facts ma'am just the facts!!! That's all mikes saying.
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Post by celo on Feb 13, 2018 12:03:09 GMT -5
You must interpret things differently than most of us I don’t see Mike being pissed. I see him working to remove obstacles one at a time and it takes a lot of time to remove each one. agree. Just the facts ma'am just the facts!!! That's all mikes saying. Angry, aggressive, pissed, attacking what ever you want to call it. The fact is the tweets he has been doing since this weekend are different than before. Before this weekend he mainly promoted how superior Afrezza is. These latest tweets are describing how unfair the insurance game is played. Pharma companies usually woo the insurance companies not scold them by what profits they are making or how they wait for their customers are visibly disabled before they will prescribe a medication. That's coming out swinging. That's the Philly kid with his back against the wall because sales are being stifled by all the insurance companies and you are going to have to raise more funds due to the lack of sales and profitability. Obstacles can be removed nicely by describing how great your product is and would you please lower the cost, or you come out with sledge hammer and start beating the crap out of them.
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Post by mnholdem on Feb 13, 2018 12:18:29 GMT -5
Acually, Mike also tweeted quite a bit last year about the unfairness of "insurance game" as you call it.
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Post by mnkdfann on Feb 13, 2018 12:25:03 GMT -5
Mike's timing of this shot across the bow, seems to be more than ironic that it occurred after the hiring of Dave. It helps when you have a person with such a large footprint in the world of diabetes all of sudden right behind your backKendall gave Mike a spine? What you wrote sort of reads that way. I really think you are reading too much into this. Mike has consistently and long spoken out against high priced drugs and unethical pharma practices. And in his tweet, he was merely responding to an article as countless others did before and since.
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