Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Cancer patients are being denied drugs, even with prescriptions and insurance

fresnobee.com

Post reply on HN
Print view View original

131–140 of 154 posts

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#131

Post by mevile »

mnm1 wrote: post #93
mevile wrote: post #45

If you're an employer in California and want to choose a provider that will not have to deal with this you might want to consider offering Kaiser to your employees. There's benefits and drawbacks, but one of the big benefits is that they're vertically integrated and the doctors, labs, pharmacies are all part of the same organization. I would think that would help avoid this specific type of situation. The big drawbac…

In that case the pharmacy might not be a problem but the doctors will delay the tests for cancer even for existing cancer patients allowing a relapse to grow unchecked for months to save Kaiser money. That's what happened to a friend of mine. So fucked regardless just to save some money.

I've never had a problem getting a test after a doctor signed me up for one, if anything I'm the one who's always been the cause of any delay.

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#132

Post by Scoundreller »

sorokod wrote: post #121
Scoundreller wrote: post #99

Earlier quoted context omitted.

The beef in the article seems to be "We're not paying for it, because it's not in our guidelines" vs. "Doctor thinks this patient is more special than the guidelines" Where in the article says that the insurance provider was trying to minimize the payout on the claim? Insurance companies really hate paying for things that don't work (or have a low likelihood of working). Even more than paying for something expensive…

> "“So we get a phone call here to my staff saying that the pharmacist – not the doctor, but the pharmacist – to the PBM called and said they are denying the drug.” The reason given: The patient should have surgery to remove his kidney first."

Also not understanding the doctor's disdain for a pharmacist calling about when to use or not use a medication. That's what they do...

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#133

Post by WalterBright »

calgoo wrote: post #109
WalterBright wrote: post #107

Having a national health care system administered by the government is the ultimate monopoly. It necessitates a gigantic bureaucracy, which will decide what you get and what you don't get according to their standardized rules. Since it will be impossible to provide everyone with the best health care, it'll get allocated according to bureaucratic rules, not what you or your doctor want. These allocations will inevitab…

As someone who lives in a system with national healthcare I can say it’s not a problem like you state. We have both private and public healthcare, and You can use both or just the public one. If you have a life threatening illness then you get priority treatment over illnesses that are more of a inconvenience. It’s not perfect, but it’s a lot better then having admin people deny you treatment based on cost alone.

Let's say you need surgery. No two surgeons are alike. Who gets the best one? Who gets the worst? Who gets neither when they're all booked up?

In national healthcare, it isn't you who decides.

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#134

Post by rosser »

alistairSH wrote: post #128
rosser wrote: post #48

Earlier quoted context omitted.

It's "theirs" in that they're the ones with absolute discretion over its disposition. It's a turn of phrase, and not meant to be taken strictly literally.

Sure, but the fact remains that by sending you to an ER instead of a GP's office caused an increase in cost to everybody in your risk pool. It's an inefficiency that shouldn't exist.

> It's an inefficiency that shouldn't exist.

I completely agree. I think it's an absurdity that shouldn't exist. My point in sharing my anecdote was to validate the prevalence of the absurdity that my comment's parent observed, though I probably could have been more explicit about that.

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#135

Post by pacaro »

mindslight wrote: post #28
pacaro wrote: post #5

This happens across the board. I have psoriasis and psoriatic arthritis. The barriers to getting a prescription for an effective (and expensive) biologic medication can be crazy. When I've been forced to use a "specialty pharmacy", they require that the medication be shipped overnight (it has to be refrigerated) which is clearly more expensive than picking it up at a neighborhood pharmacy, that shipment has to be arr…

Much of your ongoing annoyances sound like customer service problems. Can you shop around for a different specialty pharmacy? In my (limited) experience with CVS [0], they do offer to ship to a local store for pickup. I've no idea if they'd be setup to do this with refrigerated medicine, although it seems better for them than relying on a commercial carrier that will happily leave a missed-delivery tag and let the pa…

Part of the problem is that insurance has typically mandated which specialty pharmacy, and the two different ones I've used have had almost identical behavior. It's nothing overt, but the pattern seems so consistent and the end result is filling my prescription at a slightly slower rate than as prescribed, which clearly offers them a saving which probably more than offsets the overnight shipping costs.

In terms of shopping around, the most effective tactic for me is to find the job with the best insurance

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#136

Post by pacaro »

qrbLPHiKpiux wrote: post #21
pacaro wrote: post #5

This happens across the board. I have psoriasis and psoriatic arthritis. The barriers to getting a prescription for an effective (and expensive) biologic medication can be crazy. When I've been forced to use a "specialty pharmacy", they require that the medication be shipped overnight (it has to be refrigerated) which is clearly more expensive than picking it up at a neighborhood pharmacy, that shipment has to be arr…

A patient was on Humira then went on medicare. Medicare would not cover Humira and this patient had to go on Remicade. The difference? Humira is able to be given by self at home. Remicade requires an infusion by a nurse.

I actually prefer the process of going in to get the shot/infusion, not because I can't do it myself (it's a minor thing, but I find it easier to self administer injected medication than have someone else do it), but because I can just create a regularly scheduled appointment and then all the nonsense with refills becomes in invisible to me

[Edit] obviously it would be cheaper to self administer, but the costs involved aren't rational anyway. These drugs are out of patent, but no generic can be created because of the way they're made, so Abbot et al can charge whatever they want

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#137

Post by mnm1 »

mevile wrote: post #131
mnm1 wrote: post #93

Earlier quoted context omitted.

In that case the pharmacy might not be a problem but the doctors will delay the tests for cancer even for existing cancer patients allowing a relapse to grow unchecked for months to save Kaiser money. That's what happened to a friend of mine. So fucked regardless just to save some money.

I've never had a problem getting a test after a doctor signed me up for one, if anything I'm the one who's always been the cause of any delay.

That's good. If you had Kaiser, as I state above, the doctors won't send you for the test and the cancer will grow undetected. It doesn't matter if you insist they test you, they still won't. If you're lucky they won't delay long enough to kill you. But you will be worse not having gotten crucial treatment for months because the doctors are part of the racket. On the other hand, your family and friends can be happy that your suffering and death helped Kaiser get richer by saving money on critical tests.

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#138

Post by hestipod »

ta0987 wrote: post #125
hestipod wrote: post #100

Earlier quoted context omitted.

Every time this discussion comes up people tell stories of "things they heard" but I hear very little first hand experience that validates them. I have had discussions in the past with my very right wing relatives about social healthcare and quality of life abroad (where I have lived and they have not) and they always had a pocket full of stories they heard from someone that undid anything I said in their minds. A mo…

I sympathize, that's exactly what I used to assume. That there are outliers and horror stories for every system and in isolation the stories are inconclusive. Then I met this guy, in person, whose actual Canadian relatives went through this shit. Then it became real. Obviously my internet comment is not the same experience for you, being one step removed and coming from an Internet Random. And yet, having had the exp…

I apologize if it seemed like a personal jab. I am admittedly sensitive to the issue given my experiences on both sides of the proverbial exam table in the American system. Every time I try and discuss the issue with people in my area they lead with a tale about how terrible it is elsewhere and it put up a wall preventing any discussion. Rather than talking about what can work they shut it down right off the same as they do with anything they don't want to deal with...going right to the failures or abuses.

It is disheartening to see anyone in any system suffer. I am quite sure if I was someone suffering in your example's case it would be hard not to be angry at the system. When it's you hurting you don't care so much if a system if overall better, better for others, or was even better for you 99/100 times thus far, prevents a bigger problem later etc...you just want to stop hurting.

Re: Cancer patients are being denied drugs, even with prescriptions and insurance

#139

Post by charles_f »

The American health care system is a perfect system.

Its product is perfect, the only alternative the customer really has is to live in discomfort or die.

Its prices are fully unregulated.

The care providers are fully utilized and can therefore practice pretty much the prices they want.

The insurance companies are consolidating and can therefore practice the prices they want, while providing an ever dropping level of service. Consolidation with pharmacies even give them a way to control the distribution and a way to recover some of their disbursement.

Pharmaceutical producers are protecting their markets through patents that give them monopolies, which combined with a total absence of governmental overlook lets them practice the prices they want. The more the patient needs the medicine, the pricier drugs can get. The incentive is then that the deadliest the disease is, the priciest the drug gets.

The only balance that should exist with insurance weighing for lower treatment costs ends up being lower reimbursement and more borderline control on the patient.

Truly this is a perfect system, ever more efficient at extracting money from people suffering. All the incentives are in, just not weighing in the favor of patients.

Post reply on HN