# Fuck my prescription plan. Fuck it right in the ear. **URL:** \ **Category:** The BBQ Pit\ **Created:** [June 11, 2008, 11:51am UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556 "2008-06-11T11:51:52Z")\ **Posts on this page:** 16\ **Page:** 3
**Author:** ![SomeUserName](https://avatars.discourse-cdn.com/v4/letter/s/e480ec/32.png) [@SomeUserName](https://boards.straightdope.com/u/SomeUserName)\ **Post date:** [June 12, 2008, 9:07am UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/41 "2008-06-12T09:07:58Z")
[QUOTE=SCSimmons] šŸ˜› Could be CVS/Caremark, or one of the smaller PBMs that hasnā€™t yet been snapped up by one of the Big Three ā€¦ Great, now somebody will start a thread about Caremark and/or Medco, just to see if any of we shy possible PBM employees post, and exactly what disclaimers we include. :smack: [/QUOTE] I was shocked to see so many possible PBM employees in one thread. At least that NPI crap is over, well on the pharmacy side anyway. That could have been a Pit thread all on its own. **Drain Bead** I hope that someone at your company can speak with ESI and get an amendment or at least get some type of prior auth provision set up for that drug. I was pregnant a looong time ago but I can still remember the morning sickness and it sure does suck. ---
**Author:** ![Dottygumdrop](https://avatars.discourse-cdn.com/v4/letter/d/ce73a5/32.png) [@Dottygumdrop](https://boards.straightdope.com/u/Dottygumdrop)\ **Post date:** [June 12, 2008, 10:14am UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/42 "2008-06-12T10:14:37Z")
Okay, I am absolutely gob-smacked at how expensive prescription drugs are in the US! I checked out Zofran prices at [Drugstore.com](http://Drugstore.com), and the price for 120 regular 4mg tablets is $2,808.62 ($2,159.95 if you want generic Ondansetron). I was curious about whether this expense is the same elsewhere, so I looked at pharmacyonline.com.au, an Australian site. The private price (i.e. for people who cannot claim under the Australian Federal Governmentā€™s Pharmaceutical Benefits Scheme\*) for 120x4mg Zofran tablets is ā€¦ AUD$1,054.80. On current exchange rates, that translates to about US$998.53. How in the blue hell can the same drug be nearly 3 times as expensive in the US as in Australia??? What kind of sh\*t are the drug companies smoking? \*If you were an Australian resident/citizen, entitled to PBS, the total cost would only be about AUD$360 (~US$340). If I recall correctly, prescription drugs covered under PBS are generally not subject to further health insurance refunds. Drugs that are not covered under PBS may be covered by a health insurer. ---
**Author:** ![Fat\_Chance](https://avatars.discourse-cdn.com/v4/letter/f/8baadc/32.png) [@Fat\_Chance](https://boards.straightdope.com/u/Fat_Chance)\ **Post date:** [June 12, 2008, 12:26pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/43 "2008-06-12T12:26:05Z")
[QUOTE=SomeUserName] I was shocked to see so many possible PBM employees in one thread. . [/QUOTE] Me too! And I start to wonder if its possible I know any of them outside of the dopeā€¦ ---
**Author:** ![asterion](https://avatars.discourse-cdn.com/v4/letter/a/4da419/32.png) [@asterion](https://boards.straightdope.com/u/asterion)\ **Post date:** [June 12, 2008, 12:48pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/44 "2008-06-12T12:48:50Z")
[QUOTE=Qadgop the Mercotan] Use of Zofran for nausea and hyperemesis of pregnancy is quite common and accepted within the medical community. Why should she complain to her doctor about this? I too had heard the generic is available, and at a cost of pennies a pill rather than $$$$. [/QUOTE] A Chemfinder search of the generic name gives three hits: the free drug, the hydrochloride, and the hydrochloride dihydrate. Can they all be prescribed and would there be a difference in cost? ---
**Author:** ![tokaido-hokuriku](https://avatars.discourse-cdn.com/v4/letter/t/ecae2f/32.png) [@tokaido-hokuriku](https://boards.straightdope.com/u/tokaido-hokuriku)\ **Post date:** [June 12, 2008, 12:57pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/45 "2008-06-12T12:57:34Z")
Yet more evidence that the American medical system is a fucking joke. t-h ---
**Author:** ![Jayn\_Newell](https://avatars.discourse-cdn.com/v4/letter/j/f9ae1b/32.png) [@Jayn\_Newell](https://boards.straightdope.com/u/Jayn_Newell)\ **Post date:** [June 12, 2008, 1:33pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/46 "2008-06-12T13:33:01Z")
[QUOTE=Dottygumdrop] How in the blue hell can the same drug be nearly 3 times as expensive in the US as in Australia??? What kind of sh\*t are the drug companies smoking? [/QUOTE] Tell me about it. Iā€™m on anti-depressants and have been taking the same drugs both here and in Canada (one generic, one name-brand, though the generic was different on each side). In Canada, price per month, before insuranceā€“~$40 In the US, price per month, after insuranceā€“$55 I had private insurance in both cases, and was paying less for the combination up north than I am for just the generic now :eek: ---
**Author:** ![overlyverbose](https://avatars.discourse-cdn.com/v4/letter/o/9dc877/32.png) [@overlyverbose](https://boards.straightdope.com/u/overlyverbose)\ **Post date:** [June 12, 2008, 2:36pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/47 "2008-06-12T14:36:25Z")
[QUOTE=SomeUserName] I was shocked to see so many possible PBM employees in one thread. At least that NPI crap is over, well on the pharmacy side anyway. That could have been a Pit thread all on its own. **Drain Bead** I hope that someone at your company can speak with ESI and get an amendment or at least get some type of prior auth provision set up for that drug. I was pregnant a looong time ago but I can still remember the morning sickness and it sure does suck. [/QUOTE] Ah, yes. But just wait for HIPAA D.0. Even worse is Medicare, though - where the rules change every single day. Itā€™s delightful. ---
**Author:** ![The\_Tao\_s\_Revenge](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@The\_Tao\_s\_Revenge](https://boards.straightdope.com/u/The_Tao_s_Revenge)\ **Post date:** [June 12, 2008, 2:53pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/48 "2008-06-12T14:53:56Z")
[QUOTE=tokaido-hokuriku] Yet more evidence that the American medical system is a fucking joke. t-h [/QUOTE] Truth. Canada has their act together. **Drain Bead** if possible maybe looking into importing some Canadian meds is in order. Googling ā€œcanadian drugsā€ I see 90 generic zofran 4 or 8 mg tablets for $89 bucks on one [website](http://www.canadianpharmacymeds.com/productsearch.asp?name=Zofran&x=33&y=21). (I hope that donā€™t count as spamming, my trial ends tomorrow so figured Iā€™d just throw the link out now on the off chance **Drain Bead** wants it. I donā€™t have much experience with importing drugs mind you. ---
**Author:** ![Risha](https://avatars.discourse-cdn.com/v4/letter/r/5fc32e/32.png) [@Risha](https://boards.straightdope.com/u/Risha)\ **Post date:** [June 12, 2008, 3:41pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/49 "2008-06-12T15:41:46Z")
[QUOTE=SCSimmons] šŸ˜› Could be CVS/Caremark, or one of the smaller PBMs that hasnā€™t yet been snapped up by one of the Big Three ā€¦ Great, now somebody will start a thread about Caremark and/or Medco, just to see if any of we shy possible PBM employees post, and exactly what disclaimers we include. :smack: [/QUOTE] And then we benefit administrators who work with Caremark and Medco will chime in, and the real mess will begin. šŸ˜ƒ ---
**Author:** ![SomeUserName](https://avatars.discourse-cdn.com/v4/letter/s/e480ec/32.png) [@SomeUserName](https://boards.straightdope.com/u/SomeUserName)\ **Post date:** [June 12, 2008, 4:29pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/50 "2008-06-12T16:29:57Z")
[QUOTE=overlyverbose] Ah, yes. But just wait for HIPAA D.0. Even worse is Medicare, though - where the rules change every single day. Itā€™s delightful. [/QUOTE] I was just in a online meeting / conference call the other day listening and watching the hashing out of the D.0 payer sheet. Fun times! ---
**Author:** ![overlyverbose](https://avatars.discourse-cdn.com/v4/letter/o/9dc877/32.png) [@overlyverbose](https://boards.straightdope.com/u/overlyverbose)\ **Post date:** [June 12, 2008, 5:10pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/51 "2008-06-12T17:10:32Z")
[QUOTE=SomeUserName] I was just in a online meeting / conference call the other day listening and watching the hashing out of the D.0 payer sheet. Fun times! [/QUOTE] I donā€™t suppose you participate in the PCMA usergroup calls? ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [June 12, 2008, 6:04pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/52 "2008-06-12T18:04:10Z")
[QUOTE=Fat Chance] Again, the truth is, the employer and the benefit company work together to develop a formulary and coverage. The benefit company doesnā€™t arbitrarily decide what you can and canā€™t take and how much your copay is. Now, they do recommend certain coverages that minimize the employers expenses, and maximize thier own margin, but the employer can always say ā€œweā€™d like to offer our employees this drug at thier usual $!0 copay, and the company will pay the restā€. Express Scripts wonā€™t say no. [/QUOTE] Okayā€¦what? This is how the process works for smaller companies. The agent brings you various plans and cookie cutter options. It certainly isnā€™t a sit down over every detail such as ..this particular drug is for the ailment, do you want to cover it? This is your copay, this is the co insuranceā€¦specialists pay this, testing pays that and how much of a deductible to you need to have your employees pay. The insurance companies make these arbitrary rules and throws a ā€œreasonable and customaryā€ or ā€œexperimentalā€ at us when they donā€™t cover something. Maybe huge employers that have thousands of employees are offered the option of custom plans but in reality, that is the exception and not the rule. ---
**Author:** ![overlyverbose](https://avatars.discourse-cdn.com/v4/letter/o/9dc877/32.png) [@overlyverbose](https://boards.straightdope.com/u/overlyverbose)\ **Post date:** [June 12, 2008, 6:29pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/53 "2008-06-12T18:29:49Z")
[QUOTE=Foxy40] Okayā€¦what? This is how the process works for smaller companies. The agent brings you various plans and cookie cutter options. It certainly isnā€™t a sit down over every detail such as ..this particular drug is for the ailment, do you want to cover it? This is your copay, this is the co insuranceā€¦specialists pay this, testing pays that and how much of a deductible to you need to have your employees pay. The insurance companies make these arbitrary rules and throws a ā€œreasonable and customaryā€ or ā€œexperimentalā€ at us when they donā€™t cover something. Maybe huge employers that have thousands of employees are offered the option of custom plans but in reality, that is the exception and not the rule. [/QUOTE] Most smaller companies work through a TPA or larger insurance company selling group coverage who figures out the ins and outs of the ā€œoff-the-shelfā€ plan. What a lot of people donā€™t know is that the PBM is not an insurance company - they just manage the benefit. You know, adjudicate the claims, handle complaints, sometimes call center, mail order (all of the big 3 have mail order), etc. The insurance company or employer or TPA or whoever develops those plans, frequently in conjunction with the PBM or based on their recommendations, but usually has final say. Iā€™m not saying that PBMs never nickel and dime the patient - but usually itā€™s because thatā€™s what they were instructed to do so (unless, of course, the PBM is part of an insurance company like WellPoint and BlueCross/BlueShied, which is becoming more common among the really big insurance companies). ---
**Author:** ![SomeUserName](https://avatars.discourse-cdn.com/v4/letter/s/e480ec/32.png) [@SomeUserName](https://boards.straightdope.com/u/SomeUserName)\ **Post date:** [June 13, 2008, 9:17am UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/54 "2008-06-13T09:17:01Z")
[QUOTE=overlyverbose] I donā€™t suppose you participate in the PCMA usergroup calls? [/QUOTE] No. [QUOTE=overlyverbose] ā€¦ **snip** What a lot of people donā€™t know is that the PBM is not an insurance company - they just manage the benefit.. **snip** [/QUOTE] Exactly. ---
**Author:** ![The\_Tao\_s\_Revenge](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@The\_Tao\_s\_Revenge](https://boards.straightdope.com/u/The_Tao_s_Revenge)\ **Post date:** [June 13, 2008, 11:05am UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/55 "2008-06-13T11:05:18Z")
the tangled mess of who to blame the nauseated preggars chick on in this thread reads like an ad for universal health care ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [July 3, 2008, 4:14pm UTC](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556/56 "2008-07-03T16:14:31Z")
Just reviving the thread to note that Ondansetron (ZofranĀ®) is now available in generic for as low as 19 cents per 4 mg dose. At least thatā€™s what our systemā€™s pharmacy is getting it for now. [Previous page](https://boards.straightdope.com/t/fuck-my-prescription-plan-fuck-it-right-in-the-ear/452556.md?page=2)