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

141–150 of 154 posts

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

#141

Post by mevile »

mnm1 wrote: post #137
mevile wrote: post #131

Earlier quoted context omitted.

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 t…

I just haven't had that experience at all. I do use Kaiser. If anything my doctor is very aggressive about considering cancer and getting those screens, way more than I'm comfortable. My experience hasn't been the same as yours.

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

#142

Post by tzs »

threezero wrote: post #63
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…

Kaiser’s system works better than a lot of others, but for me having to drive 40 minutes for a prescription is outrageous when I have 20 other pharmacies in a 15 minute radius.

If the prescriptions are just for fairly routine drugs (diabetes, blood pressure, cholesterol, etc), I've found that most of them are cheaper paying the cash price at Walmart than the insured price at Kaiser, or paying the GoodRx price at Safeway.

What I do now is have my Kaiser doctor give me an old-fashioned written prescription on paper, take it to the Kaiser pharmacy that is in the same building as the doctor's office, and ask them what my out of pocket cost will be. While they are figuring that out, I look up my non-Kaiser options in the GoodRx app on my phone. When I get the cost from the Kaiser pharmacy, I can then decide where to actually have it filled.

It was similar before I had Kaiser. The Walmart cash price or the GoodRx price was often less than my copay with Premera or LifeWise if I used insurance.

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

#143

Post by illumin8 »

Scoundreller wrote: post #123
sorokod wrote: post #121

Earlier quoted context omitted.

> "“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."

Notice that the doctor didn't disagree with that being a course of treatment for this disease. Their response was that the patient was too ill for that surgery - a detail that wasn't known to the PBM. Either the issue is: 1) Kidney removal shouldn't be a course of treatment (unknown based on the details provided). Keep in mind, the same insurer would be paying for this, and it isn't cheap, so it's not as ridiculous a…

> Notice that the doctor didn't disagree with that being a course of treatment for this disease.

Yes, but having a PBM tell a doctor that their diagnosis is wrong and try to change their professional recommendation, without ever having seen the patient, and with unknown qualifications, is downright evil and probably malpractice.

We have doctors for a reason. They took a hippocratic oath to do no harm, and allowing unqualified people who took no such oath to tell someone to "just take out the kidney" is abhorrent.

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

#144

Post by fencepost »

RandomTisk wrote: post #86
threezero wrote: post #57

Earlier quoted context omitted.

Your anecdotes aside, the vast majority of Canadians approve of their healthcare system, something you can’t say about the US.

Which the ACA has made decidedly worse for nearly everyone. The costs have gone though the roof and since at least 2014 or so, I can only get high deductible plans though my employers.

You can hate insurance prices, and you can hate the ACA, and you can even hate Obama if you so desire, but don't hate the ACA because of insurance cost increases because it SLOWED THEM DOWN.

You're confusing correlation and causation. Health insurance costs have been rising faster than inflation for decades, but the ACA actually slowed that growth through a variety of measures - one of the simplest being that insurance companies had to be paying for healthcare with at least a minimum percentage of what they charged in premiums - prior to that they could deny everything and put the savings into executive bonuses for performance.

Some reference points with links to source information, though you may have to look at news articles for 2018/2019 numbers. The Kiplinger article notes ~5% for 2019, still well below the 9.9% average between 83-92 or the 6.4% average between 93-2010. Post-ACA, prices between 2010-2017 ran ~4.3% average increases, so it has been creeping up since 2017 for some reason cough.

https://www.thebalance.com/causes-of-rising-healthcare-costs... this one has convenient table of annual increases over the past 59 years along with notes of what major event in that year impacted costs. Source is CMS data that's inconvenient to extract on a phone.

https://www.kff.org/other/state-indicator/avg-annual-growth-...

https://www.kiplinger.com/article/insurance/T027-C001-S003-c...

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

#145

Post by masonic »

threezero wrote: post #63
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…

Kaiser’s system works better than a lot of others, but for me having to drive 40 minutes for a prescription is outrageous when I have 20 other pharmacies in a 15 minute radius.

They ship (nonperishable) meds for free.

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

#146

Post by masonic »

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.

This is a ludicrous concept. Cancer treatment is cheaper the earlier the diagnosis.

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

#147

Post by DanBC »

illumin8 wrote: post #143
Scoundreller wrote: post #123

Earlier quoted context omitted.

Notice that the doctor didn't disagree with that being a course of treatment for this disease. Their response was that the patient was too ill for that surgery - a detail that wasn't known to the PBM. Either the issue is: 1) Kidney removal shouldn't be a course of treatment (unknown based on the details provided). Keep in mind, the same insurer would be paying for this, and it isn't cheap, so it's not as ridiculous a…

> Notice that the doctor didn't disagree with that being a course of treatment for this disease. Yes, but having a PBM tell a doctor that their diagnosis is wrong and try to change their professional recommendation, without ever having seen the patient, and with unknown qualifications, is downright evil and probably malpractice. We have doctors for a reason. They took a hippocratic oath to do no harm, and allowing un…

You place a lot of trust in doctors.

Knee arthroscopy is a good example where doctors knew for a fact that they were helping patients until we ran trials using sham surgery and we found out it doesn't help some patients at all.

https://www.painscience.com/biblio/fascinating-landmark-stud...

https://doctorskeptic.blogspot.com/2012/08/placebo-surgery-4...

PBMs are probably bad, but we need some organisation to look at the evidence and say whether something works or not.

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

#148

Post by Scoundreller »

illumin8 wrote: post #143
Scoundreller wrote: post #123

Earlier quoted context omitted.

Notice that the doctor didn't disagree with that being a course of treatment for this disease. Their response was that the patient was too ill for that surgery - a detail that wasn't known to the PBM. Either the issue is: 1) Kidney removal shouldn't be a course of treatment (unknown based on the details provided). Keep in mind, the same insurer would be paying for this, and it isn't cheap, so it's not as ridiculous a…

> Notice that the doctor didn't disagree with that being a course of treatment for this disease. Yes, but having a PBM tell a doctor that their diagnosis is wrong and try to change their professional recommendation, without ever having seen the patient, and with unknown qualifications, is downright evil and probably malpractice. We have doctors for a reason. They took a hippocratic oath to do no harm, and allowing un…

> They took a hippocratic oath

Not as common as you think.

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

#149

Post by Irene »

lotsofpulp wrote: post #64
Irene wrote: post #52

Earlier quoted context omitted.

My grandmother was denied drugs by government-run healthcare and died in severe pain.

What does that have to do with taxpayer funded R&D for medicine? Presumably, taneq's point was that medicine owned by taxpayers can be sold at the cost to manufacture and distribute it at far lower costs, as opposed to the current system where the owners of the research also needed to be compensated.

Most (if not all) new medicines came out of basic research supported by the NIH. This research was tweaked and patented by companies who profit from selling the drugs. Is start-to-finish government drug pipeline a better solution? Perhaps, but current academic culture doesn't support it. It's not just about pouring more taxpayer money.

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

#150

Post by mindslight »

pacaro wrote: post #135
mindslight wrote: post #28

Earlier quoted context omitted.

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 sh…

I agree that the pattern is likely deliberate. If not explicitly designed, then at least constructively where rules kept getting added to optimize the amount paid out, leading to novel ways of saving money such as kind-of reneging on the contract.

I had thought there would be more specialty pharmacies, with the real need for them just being that those drugs wouldn't be stocked at every single branch in case someone needs them. I've personally seen competing offers (in my situation, the PBM is not CVS, and has its own mail-order pharmacy so it encourages you to switch), but haven't had to investigate them because CVS is still working fine. But why would CVS be buying up other "specialty pharmacies" if they weren't a racket of one kind or another.

Maybe insurance companies act less shitty when they're tied to Medicare (this is actually for my father), or maybe I'm also in a glass box and haven't yet noticed the walls.

Which well, is the general problem with all the ongoing political dumpster fires. "Looks fine to me" say the people who just haven't run aground yet. I do apologize if I came off that way.

Post reply on HN