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.
Okay, I am absolutely gob-smacked at how expensive prescription drugs are in the US! I checked out Zofran prices at 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 Government’s Pharmaceutical Benefits Scheme*) for 120x4mg Zofran tablets is … 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.
Me too! And I start to wonder if its possible I know any of them outside of the dope…
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?
Yet more evidence that the American medical system is a fucking joke.
t-h
Tell me about it. I’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 insurance–~$40
In the US, price per month, after insurance–$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:
Ah, yes. But just wait for HIPAA D.0. Even worse is Medicare, though - where the rules change every single day. It’s delightful.
Truth. Canada has their act together.
Drain Bead if possible maybe looking into importing some Canadian meds is in order. Googling “canadian drugs” I see 90 generic zofran 4 or 8 mg tablets for $89 bucks on one website. (I hope that don’t count as spamming, my trial ends tomorrow so figured I’d just throw the link out now on the off chance Drain Bead wants it.
I don’t have much experience with importing drugs mind you.
And then we benefit administrators who work with Caremark and Medco will chime in, and the real mess will begin. 
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!
I don’t suppose you participate in the PCMA usergroup calls?
Okay…what?
This is how the process works for smaller companies. The agent brings you various plans and cookie cutter options. It certainly isn’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 insurance…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 “reasonable and customary” or “experimental” at us when they don’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.
Most smaller companies work through a TPA or larger insurance company selling group coverage who figures out the ins and outs of the “off-the-shelf” plan. What a lot of people don’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.
I’m not saying that PBMs never nickel and dime the patient - but usually it’s because that’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).
No.
Exactly.
the tangled mess of who to blame the nauseated preggars chick on in this thread reads like an ad for universal health care
Just reviving the thread to note that Ondansetron (Zofran®) is now available in generic for as low as 19 cents per 4 mg dose.
At least that’s what our system’s pharmacy is getting it for now.