Here’s A Health To The Company (Youtube Link)

The impossible scam of US drug plans

US health insurance is a dismal swamp of scams and opacity, a system whose patient outcomes are in freefall and whose patient costs are screaming upwards on a line that it asymptotic to infinity. As bad as the whole health insurance system is, drug plans are worse.

It is literally impossible to get a good deal on drug plans. Literally. How can I be sure that this is the case? Because Wendell Potter can’t, and if he can’t, you can’t. Potter is the former top Cigna lobbyist who changed sides and became a tireless advocate for Medicare for All, dedicating himself to revealing the evil schemes behind your spiraling costs and declining health.

https://pluralistic.net/2020/03/12/boeing-crashes/#wendellpotter

Potter was one of the architects of the 2003 Medicare Modernization Act (MMA), providing talking points to the Congressmonsters who voted for it. Under MMA, Medicare was prohibited from negotiating drug prices with pharma companies. Thus Americans pay US companies 200–400% more for their meds than Canadians pay to those same US companies:

https://www.gao.gov/products/gao-21-282

Potter is now on Medicare, and so he’s got a front-row seat to the MMA’s effects, two decades on. He’s got an Rx for a Symbicort inhaler for a chronic cough, and he pays $606 every three months for this. That’s because Medicare Part D users are expected to have a drug plan, and these drug plans are all eye-glazingly complex scams:

https://pluralistic.net/2022/05/04/house-always-wins/#are-you-on-drugs

Now, Potter is an industry insider, so he knows that there are often generic alternatives to name-brands like Symbicort. He asked his doc, and she prescribed a generic, fluticasone propionate-salmeterol. That’s where Potter’s tale gets interesting (and for interesting, read “terrible”):

https://wendellpotter.substack.com/p/i-just-caused-a-long-line-at-the

It turns out that, thanks to MMA, Medicare often provides zero coverage for generics, as a condition of secret rebate deals drug plan insurers cut with “Pharmacy Benefit Managers” (PBMs). PBMs are also a scam, one of those boring, complex, useless elements of US health insurance that exists solely to produce billions for monopolists:

https://pluralistic.net/2020/12/11/number-eight/#erisa

PBMs get special dispensation to create monopolies, in the name of cutting deals that are supposed to benefit the patients who rely on them. This special dispensation was originally coupled with a legal obligation to wield monopoly buying power on behalf of patients, but the PBMs successfully lobbied to do away with that obligation. They get the privilege, but no responsibilities to go with it.

Potter’s drug plan comes from Wellcare. Sure enough, they provide zero coverage for the generic alternative to Symbicort. But Potter is a pro. He knows that services like GoodRx let you comparison shop and search for discounts to get a better deal on insurance-excluded generics than you’d get by going through your insurer.

GoodRx sent Potter to his local Rite-Aid, where a three month supply of fluticasone propionate-salmeterol costs $286.50. Now, fluticasone propionate-salmeterol isn’t actually a generic for Symbicort — it’s a generic for a similar med, from Mylan, called Wixela.

So Potter, being a pro, asked the Rite-Aid pharmacist if Wixela was covered by his drug plan, and it was — $141 for a three month supply, a $55.17/month savings over the generic.

So Potter sort-of got a happy ending. All he had to do to save $155/month was:

Know that generics exist;

Ask his doctor for a generic;

Be told that a generic didn’t exist for his med;

Press on and get a scrip for a generic of a similar med;

Use a search-engine to find a deal on his generic because his insurance doesn’t cover it;

Ask the pharmacist whether the name-brand alternative to the generic is covered

Simple!

Of course, by this point, Potter had already been paying the higher price for some time, shoveling money into monopolists’ gaping maws. There is arguably no one better equipped in America to do what Potter did, and even he lost hundreds of dollars before he managed it.

As Potter says, people with “cancer, MS, or other life-threatening conditions,” often must spend thousands before their insurance even kicks in, and even then, their insurers likely don’t cover many of their meds. That’s why so many people with insurance end up in medical bankruptcy.

By design, the MMA made Medicare Part D drug coverage impossible to decipher, “because of the ever-changing list of medications insurance plans will or will not cover,” and remember, it also banned Medicare for bargaining on drug prices.

Potter closes with a note of hope: there’s an activist called “Lower Out of Pockets NOW” that is attracting bipartisan Congressional support, with talk of forming a caucus to address pharma ripoffs:

https://www.loopcoalition.co/

In the meantime, there’s the all-American tactic of “have you tried not being sick?” coupled with “do a search on GoodRx” and “remember to ask your pharmacist about generics and name-brands.”

[Image ID: A US $100 bill. Benjamin Franklin’s portrait has been replaced with a Symbicort inhaler. The seal of the US Treasury has been replaced with the logo for Wellcare.]

I wish theyd included the scene of Dipper brutally murdering Dippy Fresh

Is anybody who had a crush of Roderick Heffley still straight and/or cisgender? No? Thought so

bye

k i’m going to put my face into a sink of cold water then i’m going to eat some salt and i’ll see if i function after 

The individual The Legend of Vox Machina character posters!

Thank you to @.devinzain on Twitter for bringing these to the fandom!