No One Has Ever Said It This Bluntly Before, But They Must Know What They Are Talking About Because Of

Hey, so one alternative to testosterone injections I don't see talked about nearly enough is pellets. I see a lot about topical testosterone, but it's not always super viable for a lot of us. I was on the patch for several months and I keep a small stock of patches in case I'm not able to get my pellets on time, but they always gave me horrific rashes and I sweat so much they usually fall off after a couple of hours. And the gel risks being transferred to pets and kids and such.

Pellets do involve needles, but you aren't going to see them. You're usually lying on your stomach while the doctor implants them in your ass or upper thigh. If you have a good doctor, they'll tell you what they're doing or have a distracting conversation depending on what you need.

And they're great if you're like me and remembering your meds is difficult. You go to the doctor once every three months, you then take it easy for a day or two so the incision can heal, and then you just get to forget about it until it's time for another dose. Because it's a steady slow release over the course of a few months, you don't really get peaks and slumps the way you would with other doses (unless you're on the wrong dose or timetable, but that's something you figure out with your doctor through blood tests and the like).

It's not just an alternative to injections, it's just super convenient. And depending on your health insurance, it may be cheaper than other methods too. (I'm on MassHealth, meaning all medications have a $3.75 copay. But because it's an in-office procedure I'm able to waive that copay and get my hormones for free, no questions asked.)

It's also super easy to microdose if that's what you want to do because of the fact that they're a bunch of small-dose pellets rather than a single implant. And there's no removal either - they just dissolve under your skin to release the testosterone.

I feel like more transmascs need to be aware of the multitude of HRT options available to us because we're constantly being told about injections and occasionally gel or patches and that's it.

Persona five, you want persona five

so sick of stereotypical 7 deadly sins character designs i want lust to be a weirdo shut-in with 47 different fetishes who buys feet pics, not a sexy man and/or woman in a corset.

hey so it’s march now aka the beginning of endometriosis awareness month and i feel obligated to remind you that debilitatingly painful periods are not normal. if you or someone you know is ending up sick or bedridden every month, you are not crazy and deserve medical attention from someone who will take you seriously

U

You guys really can't coordinate a kung pow penis huh. You've tried twice now

you may notice i use the phrase "my beloved" frequently. this is because i am in love with the world and everything in it. hope this clears things up <3

OUT OF TOUCH THURSDAY

People will spend hours watching "ending explained" videos and reading about how Ed, Edd, n Eddy is set in purgatory or some such barmy nonsense, but the moment you tell them a piece of media was motivated by racism or corporate interest in affecting public opinion or the Pentagon's funding suddenly you're reading too much into it.

zukka au where aunt wu looks straight at sokka and instead of telling him that his future is full of pain and anguish caused by his own hand, she tells him that he’s going to marry the fire lord and sokka is like “EXCUSE ME?”

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.]