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

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

#51

Post by surfmike »

taneq wrote: post #44
tasty_freeze wrote: post #36

One entirely maddening thing is that the ACA was labeled as having "death panels" that would decide who lives and dies. That phrase was powerfully effective in making large group of Americans strongly oppose the ACA. Even if they knew nothing else about the ACA, they knew they didn't want death panels. But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them. It…

The rational, informed decision is that the government should run its own medical R&D. But no, we can't do that because muh freedums.

You mean like the National Institutes of Health?

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

#52

Post by Irene »

taneq wrote: post #44
tasty_freeze wrote: post #36

One entirely maddening thing is that the ACA was labeled as having "death panels" that would decide who lives and dies. That phrase was powerfully effective in making large group of Americans strongly oppose the ACA. Even if they knew nothing else about the ACA, they knew they didn't want death panels. But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them. It…

The rational, informed decision is that the government should run its own medical R&D. But no, we can't do that because muh freedums.

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

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

#53

Post by Scoundreller »

imglorp wrote: post #19

I'm having exactly these problems, with exactly these companies: CVS and BC Anthem. Doctor writes prescriptions; some are limited in doses, some delayed, some with no copay, some priced barbarically, and some flat out refused. Then the doctor's office has wizards that help advocate and sometimes that works, sometimes there's a delay, and sometimes never. In all cases, the patient suffers. They are already facing a me…

> Then on top of that they don't get all the types and amounts of medicine their doctor actually wants, based on science and experience

It can also be the insurer saying "Nononono!" to treatments that are unnecessarily expensive.

Treatments are often chosen because of marketing, and not because of clinical guidelines. E.g. Blindly trusting a sales rep's "education", or choosing something new out of sheer boredom.

It gets dicey when the new treatment is a bit better, but a lot more expensive.

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

#54

Post by hestipod »

cheeky78 wrote: post #46
tasty_freeze wrote: post #36

One entirely maddening thing is that the ACA was labeled as having "death panels" that would decide who lives and dies. That phrase was powerfully effective in making large group of Americans strongly oppose the ACA. Even if they knew nothing else about the ACA, they knew they didn't want death panels. But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them. It…

"But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them." It's not inflammatory when it's true. When the government runs our healthcare, choices are removed and someone else gets to decide if you should get surgery needed or not...and many times this is life or death. At least now, if a cancer patient gets denied drugs, they can go to another doctor or get a se…

>I've lived in countries with universal healthcare and >the quality is sub-par compared to the US/private care.

My experience has been the exact opposite. America's healthcare business ruined my life. As a result I have no insurance and have lost the "privilege" to BUY said American healthcare. I struggle with low income options and programs, all insufficient. The only good care I ever got was in Europe. My experiences with social hospitals and doctors was much better than in the USA where it counts. Places weren't often as fancy looking, but the care was superb. Even the private systems in those countries was far more affordable. a few hundred for an MRI etc rather than a few thousand.

Healthcare and education in America can bankrupt you. That isn't something people in countries with social options have to fear...despite any drawbacks since no place is perfect. I don't know if Americans who are so opposed to doing things like the rest of the first world just need to believe it's always better here so they ignore the benefits...or if they just haven't had to face this issue personally and are incapable of caring until they do. But I do know I had a future and now I do not...and there is no net to catch me or care. Whenever I see comments like yours I just get so upset realizing how it's an unwinnable battle in this country because of these ingrained beliefs.

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

#55

Post by lotsofpulp »

maxerickson wrote: post #35
lotsofpulp wrote: post #18

Earlier quoted context omitted.

I guess, but the nuance is that the PBM is only doing what the payer wants it to do. If a state tells the PBM to only approve payment for certain medications under certain circumstances, I don't see the purpose of blaming the PBM for this. Similary, if an employer chooses a formulary that results in a denial of payment, it's the employer who chose to not cover payment for the medicine. The state or the employer can c…

And the payer can state that the PBM only offers a limited set of options, each hand washing the other.

The payer cannot state that, but they do have limited funds so they're not able to say "approve every prescription". Payers are not forced to use PBMs, they choose to to achieve their goals, such as staying within their budget.

My whole point is that blaming PBMs is a waste of time. With or without PBMs, someone working at or for the payers (employers, insurers, governments) will be approving and denying claims, just like they have to for home and auto and any other insurance claim.

The correct person to blame is us, the voters, for not voting for taxpayer funded healthcare for everyone. But even then, there will probably be some type of setup to ensure healthcare providers are not abusing and defrauding the system, hence someone to approve and deny payment from the government.

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

#56

Post by roberte3 »

I have a really rare cancer, and it didn't get detected until I hit stage IV and it started shattering my bones. Thankfully I lived 2 miles from a cancer research hospital that actually has a specialist in this type of organ cancer.

My current treatment regime is based on a research paper. My insurance initially denied me treatment based on "an expert in the field" and stupidly listed the doctors name. I looked her up and she was a podiatrist...

For the most part, my treatment is dialed in and mostly working. But I had a solid three months of fighting with the insurance company to get all of the medications, and I do the monthly phone calls to three different specialty pharmacies to get all of the various things that keep me able to walk.

Its a crazy hard problem because one of my medications is a "failed" cancer drug. Tens of millions of dollars worth of R&D, several clinical trials, and it turns out it doesn't work on most common cancers. (And even on cancers it does work on, its usually used as a Hail Mary play, at EOL because it might give someone a few more weeks, maybe). It costs roughly 40k a month, and I might be stuck on it for the rest of my days.

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

#57

Post by threezero »

cheeky78 wrote: post #46
tasty_freeze wrote: post #36

One entirely maddening thing is that the ACA was labeled as having "death panels" that would decide who lives and dies. That phrase was powerfully effective in making large group of Americans strongly oppose the ACA. Even if they knew nothing else about the ACA, they knew they didn't want death panels. But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them. It…

"But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them." It's not inflammatory when it's true. When the government runs our healthcare, choices are removed and someone else gets to decide if you should get surgery needed or not...and many times this is life or death. At least now, if a cancer patient gets denied drugs, they can go to another doctor or get a se…

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

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

#58

Post by lotsofpulp »

erentz wrote: post #30
lotsofpulp wrote: post #20

Earlier quoted context omitted.

>They also have the ability to override the policy. From my understanding, they do not. At least not outside of a certain margin of error, since the payer (for example a state government or employer) would then blame the PBM for approving payment something it wasn't supposed to approve payment for, and hence seek reimbursement from the PBM or cancel its contract and go with another PBM.

I’ve had specialty medicine approved that very clearly goes against policy at different phases of the review process (including immediately) on different insurance plans. So they do seem to me to have this power.

I can't answer for why they would violate the policies they are supposed to be enforcing, but I do no know PBMs get audited by governments and penalized for improperly approving medications for Medicaid recipients.

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

#59

Post by taneq »

Irene wrote: post #52
taneq wrote: post #44

Earlier quoted context omitted.

The rational, informed decision is that the government should run its own medical R&D. But no, we can't do that because muh freedums.

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

That is awful and I'm so sorry to hear. :( It also doesn't invalidate my point, although it highlights that I should have said the government should run its own competent R&D

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

#60

Post by monetus »

hestipod wrote: post #54
cheeky78 wrote: post #46

Earlier quoted context omitted.

"But as this article demonstrates, if we care to use the inflammatory "death panels" label, we already have them." It's not inflammatory when it's true. When the government runs our healthcare, choices are removed and someone else gets to decide if you should get surgery needed or not...and many times this is life or death. At least now, if a cancer patient gets denied drugs, they can go to another doctor or get a se…

>I've lived in countries with universal healthcare and >the quality is sub-par compared to the US/private care. My experience has been the exact opposite. America's healthcare business ruined my life. As a result I have no insurance and have lost the "privilege" to BUY said American healthcare. I struggle with low income options and programs, all insufficient. The only good care I ever got was in Europe. My experienc…

To add to your anecdote: I have a bill laying around where the asking price for the mri was $21000.
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