Formulary Alternatives

[Florence]

Even with Medicare and Humana Medicare Advantage healthcare is complicated. My husband has mild asthma which is well controlled with 2 inhalers--one is a nasal spray and the other is an oral inhaler. Since his retirement, we are now on Medicare and have Humana Medicare Advantage. I spent hours on the Humana website today figuring out what brand they have on their formulary and whether it would be better to purchase them at the local CVS pharmacy or use their mail order pharmacy for a three month supply. And I have been a Pharmacist for 20+ years! And I still had trouble figuring it out! I think I have it sorted out finally. Using their mail order pharmacy is the least expensive. Now I need to check with the M.D. to see if he will just write or fax in the new prescriptions or if DH will need to come in for an office visit. :(

[Lainey]

Florence,
Hope you can just get the new script written up without an office visit.

I've been thinking this week about similar stories from friends, family, co-workers, etc. and I was wondering if we totaled all of the person-hours from everyone in the U.S. who has to sort out their medical insurance stuff just in terms of lost productivity we could see what a drag on our economy it is.
I can't imagine Canadians, or most others in the first world have any idea how mind-numbing and time-consuming this nonsense is.

[Florence]

Thanks Lainey. DH and I are in good health and well educated and we are boggled with the system. I can't begin to tell you how complicated figuring out whether to have Medigap insurance or a Medicare Advantage plan was!! I cant imagine how someone who is really sick, poor, or uneducated could possibly cope with it!!

[IshbelRobertson]

I have asthma, as well as a couple of other on-goingconditions, necessitating prescription drugs.

In the UK, the current charge per drug on the NHS is 8.05 GBP. Doctors usually prescribe the drugs for ongoing conditions by 2 or 3 month supplies, meaning you still only pay the one charge for three packs. Certain illnesses mean exemption from all charges for ANY meds you may require. For example, if you were diabetic and needed asthma meds or antibiotics or blood pressure meds, they would also be free. Children and those over retirement age are also entitled to free scripts and I think pregnant women may also qualify. if you suffer from ongoing conditions for which you are not entitled to free prescriptions, you can buy pre-paid charge accounts from the NHS, for varying lengths of time, three months, six months or a year covering all drugs required. Fine if you know you are going to need drugs, but a gamble!

Of course, when I say 'free' we do, in effect, pay through our national insurance contributions!

ETA Because of my ongoing conditions, I no longer pay for any meds, although when I only needed meds for asthma, which is not a 'free scrip' condition, I did!


Simple system that everyone understands!

[catherine]

Simple system that everyone understands!

That's what we are in dire need of. Simpler translates into cheaper all around.

The ACA may be the first step in universal health care, but it's a far cry from ideal... this is the messy transitional phase where everything gets pulled out of the closet and it looks like a big mess. We need to think about how that stuff gets rearranged, but it's going to take a while.

Hopefully someday, we'll have a nice tidy "closet" like our UK and Canadian friends.