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Treat Medicines Like Netflix Treats Shows

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Re: Treat Medicines Like Netflix Treats Shows

#121

Post by Wowfunhappy »

fwip wrote: post #50
KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

There isn't always an objective best treatment for a patient. Doctors should have license to use their knowledge of the patient and accumulated wisdom to prescribe what they think would be most helpful. We have a list of drugs that work, it's the list of FDA-approved drugs. Insurance will already try to get out of paying for anything that doesn't seem "normal."

> We have a list of drugs that work, it's the list of FDA-approved drugs.

Which doesn't take price into account.

And there's no reason for the patient or doctor to take price into account when insurance is paying for 95%+ of the cost.

This is the classic "someone else's money" problem.

Re: Treat Medicines Like Netflix Treats Shows

#122

Post by [deleted] »

ameister14 wrote: post #42
KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

>For insurance to work, US doctors must follow national guidelines laid out by a scientific body (ie NICE in the UK) any deviation without justification would/should lead to fines and censure. I don't think that's necessary for insurance to work - I think it's necessary for medicine to get cheaper. If I want a specialist to treat me as an individual and potentially prescribe something outside the norm, I should be ab…

[deleted]

Re: Treat Medicines Like Netflix Treats Shows

#123

Post by Godel_unicode »

Wowfunhappy wrote: post #120
phonon wrote: post #110

Earlier quoted context omitted.

Yes, those are "Dispense as Written" (DAW) Laws. http://beta.aan.com/globals/axon/assets/4698.pdf In most states, just using the trademark name instead of the generic is not sufficient (which makes sense, since the generic names are usually quite wordy and hard to remember) the doctor needs to specifically write "DAW" if a generic cannot be used.

This begs the question, under what circumstance would it be reasonable for a doctor to insist on "Dispense as Written"?

Generics are not guaranteed to be identical, especially in the inactive ingredients. It is rare but not unheard of for someone to have a reaction only to one form of a drug.

Edit: I have a friend who has such an allergy, which was confirmed with double blind testing.

Re: Treat Medicines Like Netflix Treats Shows

#124

Post by will_brown »

Wowfunhappy wrote: post #119
will_brown wrote: post #90

Earlier quoted context omitted.

You are asking me to cite things but what are you citing? You are simply saying “that’s not true”. >MTM has nothing to do with insurance. It’s required by law To be provided by insurers/health plans. If you refuse to talk to pharmacists or doctors about it, fine, you can read the law 42 CFR 423.153. In short insurance companies, must provide MTM services to patient covered in their plans. It is also the single bigges…

> You are asking me to cite things but what are you citing? GP cannot prove a negative. If this software/system exists, the "burden of proof" is on you.

He said mtm has nothing to do with insurers and ask “where I got my ideas” I said CMS and cited the Law that Medicare insurers have to provide mtm to patients.

Then he said outcomesMTM is a pharmacy patient management software having nothing to with insurance, but it’s a software for insurers to pay pharmacies to provide mtm to the insurers patients and I quoted from their website. It’s really above and beyond ridiculous like me saying google is a search engine and someone say no it’s not give me a cite.

Re: Treat Medicines Like Netflix Treats Shows

#125

Post by qqqwerty »

tathougies wrote: post #111
simonebrunozzi wrote: post #107

Earlier quoted context omitted.

Do you mind sharing some details, without naming names? I'm curious to know more about the specific issue.

Sure. My wife had lost several pregnancies, including late losses. All sudden. There was no explanation ... tests all normal. Went to several MFMs at UCSF, Stanford, Mayo Clinic, etc, who told us that there was no evidence backed treatment to offer. Her obstetrician (been in practice almost 50 years) told my wife that she had a blood clotting disorder (although the tests certainly did not indicate that, at all). She…

I am very sympathetic to your ordeal. But I would also like you to consider a few counter points.

Consider this very hypothetical scenario. For a particular diagnosis, an experimental treatment improved outcomes compared to a control group by 40%. That may seem promising, but if the control group success rate is 10/100 and the treatment group success rate is 14/100, that means the NHS would need to treat 100 people to get 4 additional positive outcomes. If the treatment is really expensive or if it has severe side effects, then quite frankly, cost benefit needs to be considered. And another thing to consider, is its possible that your treatment was a false positive. It might seem crazy to you based on your experience, but the population is very large, and there will always be those 'exceptional' cases. That is just how it works.

Also, the OP qualified his remark with the words 'deviation without justification'. It sounds like in your case the OB had plenty of justification because she was aware of studies with more comparable demographics that had better success. So really, it sounds like you just got lucky in that one of your specialists happened to have the right background. If you had had a different OB, then you would have been no better off in the US system.

And finally, a personal anecdote. I suffered a fairly nasty shoulder injury playing a contact sport. The injury (completely tore my AC joint) is quite common for the sport. My HMO (Kaiser) did not recommend surgery because it only has moderate success, and even if successful, it only marginally improves quality of life compared to no treatment. Somewhat coincidentally, 3 other teammates had the exact same injury that year. One was on Kaiser, and also did not get the surgery. The other two were on PPOs and both got the surgery (I largely suspect due to the financial incentives of PPOs, they tend to over-treat). In terms of recovery, I was mostly back to full function in about 6 weeks, whereas the surgery involved a 3-6 month recovery process. And after 4+ years, I have some minor stiffness every now and then but nothing too bothersome. So basically, every time you (or your company) pay your sky high insurance premiums, just realize that some portion of that money is going to pay for mostly unnecessary shoulder surgeries for recreational athletes.

Re: Treat Medicines Like Netflix Treats Shows

#126

Post by KaiserPro »

evoloution wrote: post #92
KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

Your statement sounds pseudocorrect but the underlying assumptions are that: a) we are currently able to diagnose all nosological entities efficiently, b) we know which treatments are working for each of said entities and c) all people react the same to the same medications, d) all medications that are indicated to treat a disorder are equal. Oh boy, wouldn't that be nice... In reality you have an army of paper pushe…

in reply to point a), b), c) and d):

it already exists: https://bnf.nice.org.uk/ There is a companion to the BNF that has the prices of all the brand/generic versions of the drug.

Doctors don't just randomly prescribe anything, they already _have_ guidelines. and based on actual patient information (like interactions or lack of improvement) they will change drug type based on the evidence. Again, look at the BNF for interactions and contra-indications

for example look at this for nose infection: https://bnf.nice.org.uk/treatment-summary/nose-infections-an... a list of four drugs and an order to try. Notice that its drub clases, not brands.

Doctors should not be allowed to prescribe brands in the states until the corruption is under control

Re: Treat Medicines Like Netflix Treats Shows

#127

Post by KaiserPro »

tathougies wrote: post #77
KaiserPro wrote: post #37

This is insurance. Literally insurance. You pay a monthly fee in return for a good, service or cash payment should something happen. however in the USA, something odd has happened. For what ever reason, be it legal, cultural or other, copay, crippling buerocracy and down right greed has stopped the health system working properly. The problem with a "netflix" model, is that doctors can currently prescribe anything, re…

> US doctors must follow national guidelines laid out by a scientific body No thanks. My daughter is alive today thanks to a therapy that would not be sanctioned by 'standards bodies'. I'm good. Thank goodness her doctor was a professional that was able to make professional judgements. If you want to reduce doctoring to looking up values in a dictionary, I suggest you try that with you and yours first, before forcing…

My wife is a paediatrician in the NHS, Those very guidelines are _always_ evolving.

During training in the NHS a doctor is expected to do/participate/author at least one study during their time in training. Thats at least 8k studies a year from junior doctors alone.

Of course I want doctors to make professional judgements. But, I also want gross mistake to be prevented. For example dumping a 7 year old with textbook _textbook_ autism on lithium, because they had "rapid cycling manic depression" (why is that bad? a) because MD is vanishingly rare in pre pubescent, and unheard of in 7 year olds outside the USA, the risks of suicide when coming off lithium is 1/3)

in adult land when someone has Tonsillitis, prescribing them an expensive co-amoxiclav generic ($50 a _pill_) when the brand the cheapest generic was $20 for the entire course. (as it was a primary infection and showed no resistance, amoxicillin should have really been used.)

Re: Treat Medicines Like Netflix Treats Shows

#128

Post by KaiserPro »

tathougies wrote: post #111
simonebrunozzi wrote: post #107

Earlier quoted context omitted.

Do you mind sharing some details, without naming names? I'm curious to know more about the specific issue.

Sure. My wife had lost several pregnancies, including late losses. All sudden. There was no explanation ... tests all normal. Went to several MFMs at UCSF, Stanford, Mayo Clinic, etc, who told us that there was no evidence backed treatment to offer. Her obstetrician (been in practice almost 50 years) told my wife that she had a blood clotting disorder (although the tests certainly did not indicate that, at all). She…

My wife is a paediatrician in the NHS, and before that did several rotations in OB.

I'm sorry you had a terrible time, but it is standard practise to prescribe Enoxaparin for recurrent miscarriage in the NHS: http://formulary.panmerseyapc.nhs.uk/chaptersSubDetails.asp?... Sure you can test for it, but in the absence of anything else, its a cheap, and not overly invasive. So its fair game for prescription. (My wife has had it twice.)

its also fairly cheap to the NHS (40mg preventative dose is £30(~$40) for ten doses https://bnf.nice.org.uk/medicinal-forms/enoxaparin-sodium.ht... so about £840(~$1100) for a 40 week course)

However a GP shouldn't really prescribe it, without the patient seeing a specialist first. In the NHS at least it would be the gynae department that would prescribe it. More importantly the NHS pays for what ever the doctor prescribes regardless of what it is. There is no concept of "here is the drug you should have, but you have to pay for it out of pocket"[1] the NHS is incharge of getting a good price.

[1] There are very rare cases like specialist proton therapy in certain cases, or new cancer therapy drugs. they account for less than 0.1% of all cases, unlike the states where ~20% of the populous can't afford basic drugs, like routine pain meds, or antibiotics. Also, there is no concept of cutting people off if they have spent to much. So chronic conditions are treated regardless.

Re: Treat Medicines Like Netflix Treats Shows

#129

Post by mnm1 »

It really boils down to what a society values. Does it value caring for people and health or does it value hurting people for profit? We have the tools to be caring but in America, we generally don't use them because we value companies' profits above all else. We let corporations profit as much as they want off the suffering of others. We used not to, as the article points out. We can override patents. We can see drug users as human. We can try to eradicate diseases like hep c. Or we can go our current path and let corporations profit while millions die. It's really a cultural issue. Do we want to be compassionate or do we want to exploit our own people? That is the question being asked when we talk about reducing drug prices and having national healthcare instead of the vile insurance and drug industries we support now. It's not looking too hopeful for compassion at the moment.

Re: Treat Medicines Like Netflix Treats Shows

#130

Post by mnm1 »

patmcc wrote: post #59
will_brown wrote: post #46

Earlier quoted context omitted.

>The problem with a "netflix" model, is that doctors can currently prescribe anything, regardless of cost or efficacy Unknown to almost everyone in the US is that if you are a Medicare patient, when you go to fill a Rx before the pharmacist fills the therapy, insurance software suggests cheaper generics to the pharmacist and requires the pharmacist to do the leg work of asking the doctor to change the Rx based on wha…

While I agree insurance companies do harm, encouraging generics is probably a net benefit. Doctors, just like anyone else, respond to marketing, so they remember 'viagra' more easily than 'sildenafil' and write prescriptions accordingly. There's often no medical reason a generic isn't 100% suitable.

That's great, but in this case even the generic costs $450 to $950 for a typical two week to a month bottle. I can't imagine how much the brand name costs if the generic costs that much. There are some alternatives like blink health (I have no affiliation) that bring that cost down to about $45 by negotiating prices en masse, I assume. If that's not a broken system, I don't know what is. Clearly, these medicines could cost a lot less but they don't because companies' profits are more important than health in America. Or take genetic tamiflu (can't remember the name). $150 for one course. I'd rather risk the flu, which I recently have, than take it preventatively. Can't imagine how much that brand name costs either but it it's unaffordable even on an engineer's salary, what's the use of even having this drug? Even with my insurance it was over $110. What's the use of having insurance in that case? Still unaffordable. Still going to get sick. What a fucked up system.
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