My dental plan is separate form my medical insurance and pays at a 100 percent.....My husband's employer also offers a wellness plan that gives us a free gym membership and some other fun perks
The biggest benefit was that all my daughters were covered up to the age of 25 as long as they were in school. That was immensely helpful for our youngest who had to have frequent tests and doctor visits because of her cancer..........
edited to add that my deductible is 250.00
Lynn492009-04-06 20:22:41
Yes, there are many in the US that have health insurance with good coverage, but the numbers are declining. Many get health insurance through their employer but with health care costs increasing, employers are passing on costs to their employees in higher premiums, higher deductibles and copays, and less coverage. One's health insurance coverage can depend on the size of the employer, big businesses can offer better, more affordable plans, small businesses may not be able to afford to provide health insurance to their employees at all.
And, if you lose your job, you may not be able to afford health insurance through COBRA or in the individual health insurance market. And if you have a preexisting condition, then an insurer can deny you an individual health insurance plan.
If you have a good plan, one could pay a small copay for prescriptions, like to a month. But the prescription drug benefit and cost will vary from plan to plan, and some drugs may not be covered at all. And, your drug plan can change from year to year, with drugs dropped or added.
Myself, I pay for a month supply of enbrel. If I had no insurance, I'd have to pay the actual cost, which is over ,500 a month. The manufacturers of some biologics have assistance programs, and cover all or some of the cost, but I don't know for how long.
There is a government program, Medicare for those over 65 or disabled. The drug benefit plan is called medicare part d. Some "specialty drugs" like biologics are "Tier 4" drugs, and may cost up to 40% of the actual cost of the drug.
The US health care system is a patchwork of private health insurance and public health programs. Some of us have very good health insurance coverage, and some have no access to medical care or meds, and die as a consequence. Last night, on the CBS t.v. program 60 Minutes, there was a story about the public hospital in Las Vegas, Nevada, that had to cut services. One was the outpatient care for cancer patients, people receiving chemotherapy. These people, some who had lost their jobs because they became sick, now were left with no treatment.
Yes, no country's health care system is perfect, without challenges, but surely, the US can do better.
Edited to add link to 60 Minutes program, "The Recession's Impact: Closing the Clinic"
http://www.cbsnews.com/stories/2009/04/03/60minutes/main4917055.shtml
Joie2009-04-07 09:48:20I expect the US to do better. There was something in the paper recently about the vets in Cali not getting treatment??? I'm like...they're vets, just back from the war, OMG!
Maz - I don't understand what you meant. Your medications aren't covered????
Lyndee - get this, this isn't a new fangled under patent med - my med is an OLDER, off patent, drug and had an increase in cost in the first 1/2 of 2006 of over 350%. Do I think it's criminal - yes, as a matter of fact I do. My AP doc believes absorption issues for AI people means we need the Brand - but good old MedCo won't give it to me.
We have to pay for blood tests and my AP doc is pulling blood at every visit. Vials and vials of it. Our last set of bills from him was over 2K (before the insurance kicks in) because we have this HUGE deductible now that we didn't have even last year. Then we paid over 1K in the meds coming in from Canada (got a 3 or 6 month supply), can't remember what they said it was for because BOTH of us get our meds from there now just to afford to stay afloat.
Is it true that in 'socialize medicine' countries you guys get your supps covered too? Because that's hundreds of dollars a month for the both of us and I don't want to give those up. In my opinion, my AP and my supps are why I don't have any pain and I sure as heck wouldn't know what to give up if I had to do it. My Melatonin? Over my dead body! My potassium, my magnesium or calcium?
Pip
What do they say, that 45 milllion US citizens are uninsured? Of those, many are uninsured by choice, they'd rather spend their dollars on other things. Which is, of course, their choice. But considering the US has a population of over 300 million, and the fact that we pick up the tab for all of our illegal aliens (do the AUstralian tax payers have to do that?), it's not as bad as some people want everyone to think it is. Sure, it's not perfect. It needs some revamping, no one could argue that. But why would we make the swictch to a different system that is known to be not perfect either? That makes no sense. Better to fix what we have.Because it's better to start afresh in most cases. The fraud going on here with Medicare/Medicaid etc is astounding (and the lead anti-health care guy is responsible for over a billion dollars of that). A free market means the rich get richer and the poor get poorer and ANY regulation goes out the window.
Linncn - did you watch that PBS special "Sick Around America"? That guy making 63K a year can't afford the premiums for insurance. That woman with Lupus who died not of that but of 'a failing health care system'. She got over 900K in treatment trying to save her necrotizing organs and by then it was too late and she was dead.
I haven't finished watching it yet - it upsets me so much I have to turn it off and start up again. That can be us...easily...with the economy going the way it is...south. Over 600,000 new unemployment claims last week ALONE. So, even if somebody has their your own small business, it's going to start hitting them soon.
Pip
Pip, what about the hundreds of millions of Americans that do get the healthcare they need? Does this special say even one thing about us? Or do we just not exist to them because we throw a wrench in their agenda? As I said twice already, yes we need to make some improvements in our system. Bu to socialize our system would be like exchanging your tire with the slow leak for another tire with a slow leak. Isn't it better just to fix the tire?
Linncn, anecdotal evidence about people who fall through the cracks are only allowed if you're bashing the US. They're not allowed if you're showing problems with other countries' systems, or showing a glaring success here.
That seems to be the rule of thumb for the, what is it, The Propaganda Broadcast System? Talk about your scare tactics. Geez.
"Socialized medicine" is a system like the UK, health care is paid through taxes, the government administers the National Health Service, and doctors are paid salaries or paid on the number of patients they see. Neither Congress nor the Administration is proposing socialized medicine.
There has been legislation introduced for a single payer system, where the government would administer health care, patients would have choice of doctor/hospital, and doctors/hospitals would remain private. It has little support with Congress, though supported by many doctors and citizens who believe health care reform that keeps private insurance in the mix is not financially sustainable.
What is being hashed out in Congress, is reform that would build on our current system of private and public plans. One point of disagreement is whether a public plan should be made available to compete with private insurance. A public plan would be an affordable option for workers whose employers don't provide insurance, those with preexisting conditions, or early retirees who are not yet 65 and do not qualify for Medicare.
Our health care system is in trouble. Since the last reform efforts of 1994, nearly 9 million more Americans are uninsured; Six million more working people are uninsured in the United States; average costs paid by an employee for an individual health insurance
premium have risen nearly eight times faster than average U.S. incomes; and the percentage of nonelderly people with private health insurance has
decreased to just 67 percent, down 6 percentage points nationwide.
While uninsured workers cannot afford to pay for health insurance to cover their families, they pay payroll taxes to cover health care for those on Medicare and income taxes that pay for health care for the poor.
In the 1990s, there were eight states with 20 percent or more of the
working age population uninsured. Now there are 14: Alaska, Arizona,
Arkansas, California, Florida, Georgia, Louisiana, Mississippi, New
Mexico, North Carolina, Oklahoma, Oregon, South Carolina and Texas.
The numbers referenced above are from analyzed Census data through 2007, the latest year available -- before the economy tumbled into recession -- so for workers, the situation has gotten worse.
http://www.cbsnews.com/stories/2009/03/24/health/main4888064.shtml?source=related_story
http://www.rwjf.org/newsroom/product.jsp?id=40449
Many of those states also have the highest illegal immigrant population. Hmm...
Great article Joie.....very well put. This is basicly what I was saying on the other thread but not as well as you put it. Even the sound of SOCIALIZED MEDICINE scares the crap out of everyone down there because they think we are a socialized nation. All that is socialized is the medical system and it is very similar to N.Z. and U.K. but not the same. As I said before....take out the parts that are not working and replace it with something that will. Would I like %100 of my prescription costs taken care of..yes but I guess I will have to take the %90 and not complain.
Pip...we have to pay for our own suppliments but they are not that expensive. I don't have any prices off hand but the ones I use are mostly and under.
TeedOff2009-04-07 12:46:40I'm mostly off medication, not because of the cost of medicine, but because I can't budget a 0 dr visit on a regular basis. I'm taking a near minimum dose of amitryptaline. I might see about getting to a local clinic when I get close to running out. 90 days at full dose is just at the local Wal-Mart. Too bad it's not OTC.
[QUOTE=TeedOff] Would I like %100 of my prescription costs taken care of..yes but I guess I will have to take the %90 and not complain.
I don't mind paying for a portion of my drugs. What I do mind is my health insurance making seemingly arbitrary decisions about which drugs I can take without penalty.
I have migraines. If I choose to take a drug in the triptan class (non-addictive migraine abortive drugs such as Imitrex etc ) I have to pay damn near full price. The lowest cost drug was Relpax at 2 for SIX doses. If I want to take narcotic pain killers for my migraines, I pay for 30 doses. How much sense does that make?[QUOTE=JasmineRain] [QUOTE=TeedOff] Would I like %100 of my prescription costs taken care of..yes but I guess I will have to take the %90 and not complain.
[/QUOTE]
Yea, I'd like a free house and an all-you-can-grab buffet down at the grocery store too.
Seriously - why is it so wrong to ask people to pay even a portion of their healthcare, considering they have to pay for the other necessities in life such as food, clothing and shelter?
[/QUOTE]
Why do you think we are not paying a portion of our healthcare as well of the other necessities in life. This is all taken care of through the taxes that we pay.
TeedOff2009-04-07 15:52:17
[QUOTE=TeedOff][QUOTE=JasmineRain] [QUOTE=TeedOff] Would I like %100 of my prescription costs taken care of..yes but I guess I will have to take the %90 and not complain.
[/QUOTE]
[QUOTE=TeedOff]Here we go round the mullberry bush! We pay for our own food and clothing and whatever necessities we need or want. We are talking healthcare here. [/QUOTE]
I am talking about excessive government intervention. I don't want them picking out my house, I don't want them picking out my dinner, I don't want them involved in my healthcare. I think there are definitely areas that need improvement, particularly for folks physically or mentally unable to care for themselves. But I don't believe we need to toss out everything. My taxes are high enough. Don't tell me they won't increase to pay for this - I know better.
[QUOTE=JasmineRain] [QUOTE=TeedOff]Here we go round the mullberry bush! We pay for our own food and clothing and whatever necessities we need or want. We are talking healthcare here. [/QUOTE]
I am talking about excessive government intervention. I don't want them picking out my house, I don't want them picking out my dinner, I don't want them involved in my healthcare. I think there are definitely areas that need improvement, particularly for folks physically or mentally unable to care for themselves. But I don't believe we need to toss out everything. My taxes are high enough. Don't tell me they won't increase to pay for this - I know better.
[/QUOTE]
What government intervention are you talking about? MG woman, where in here have I said anything about the government picking my house, my dinner, my clothes, where I go to school, what hospital I want to go to, what Dr. I want to see? Quit jumping to conclusions and assumptions. Where, at anytime, have I said to any of you that this is healthcare you should choose? How do you know your taxes will be increased? Quit throwing the baby out with the bathwater and at least see what is proposed to you. If you don't like what is proposed then reject it. If you have a closed mind about everything, nothing will ever be accomplished.
Pat
hmmmm, gimping along..singing a songOK Pip lets see if I can explain this to you, it isn't easy to understand if you haven't come across it, and believe me it isn't easy to explain either .... lol
If I go to a doctor or specialist for a normal consult that doctor may charge me .00 a visit ... now the Government rebates some of the cost by what they call the 'scheduled fee' meaning they believe the doctor for instance should only be charging their patients say a visit not -- so the government will give you back the and you are out of pocket the rest.
With pathology, MRI's CT scans, ultrasounds and stuff like that - we have to pay for those on the day of the tests - for instance if my doctor scheduled my MRI it would have cost me 0 to have it done, but in my case because it was ordered by a hospital it doesn't cost me anything.
Then there is the problem of medications .... they too are rebated by the government at the point of sale .... but it depends on what medication/s you are on as to how much it will cost you. As a family if you spend over 00 a year on medications it is all claimable on your tax, but if you don't reach that limit you are out of pocket whatever it is. For instance my son needs medication for a life condition - his meds were 0/mth - so his doctor found an equivalent medication for him that only costs him /mth ...
If you are on any kind of pension or the dole you only pay .20 per script for your medications and zero for doctors visits. (All children's doctor's visits are free of charge)
The medical insurance only covers the hospital bed & related costs as an inpatient, so in my case for the hyster - the specialist is zero cost to me, the anaesthetist costs more than the scheduled fee so I will be 0 out of pocket, the hospital bed, theatre etc costs with whatever, costs whatever they are, I have medical insurance with an excess of 0, so I will be out of pocket 0 for that stay (ie 0 for the medical excess plus 0 for the anaesthetist). But I can claim all of it back in tax.
My medical insurance also covers dental, chiropractic, naturopathic and a few other things, so I can get a % back for anything that comes under that.
Hope you understand,
Maz
System kept booting me out, so I edited to finish the post
Maz-aust2009-04-07 17:10:46[QUOTE=Maz-aust]OK Pip lets see if I can explain this to you, it isn't easy to understand if you haven't come across it.
If I go to a doctor or specialist for a normal consult that doctor may charge me .00 a visit or specialist may charge me 0 a visit ... now the Government rebates some of the cost by what they call the 'scheduled fee' meaning they believe the doctor for instance should only be charging their patients say a visit not -- so the government will give you back the and you are out of pocket the rest.
With pathology, MRI's CT scans, ultrasounds and stuff like that - we have to pay for on the day of the tests - for instance if my doctor scheduled my MRI it would have cost me 0 to have it done, but in my case because it was ordered by a hospital it doesn't cost me anything.
[/QUOTE]
See, ours is different again. When I go for a Drs visit, be it GP or Specialist, that is taken care of by the government. We never see a bill or are we told what the amount is. The same goes for lab work, exrays, ct scans, MRI or any other type of test. The only thing we are accountable for is prescriptions...we pay full amount to the pharmacy then submit the whole thing to extented health, after paying the first .00, we receive 80% of the total. We submit the amounts either every six months or a year. Sooner if you have a whole bunch.
There you go - I need to migrate to NZ ....
Interesting isn't it that it is all different ... really hard to figure out which actually in reality works best for the patient ...
[QUOTE=Maz-aust]There you go - I need to migrate to NZ ....
Interesting isn't it that it is all different ... really hard to figure out which actually in reality works best for the patient ...
[/QUOTE]
Why not Canada?
I think it is all in what we get used to. Probably you pay a lower I.T. or other taxes. It probably all comes out in the wash.
Pat
TeedOff and Maz,
Often here in the US, folks lump together all countries that have universal care as being the same.
Your posts show that Canada's and Australia's health care systems are different. I know Canada is a single payer system, but is Australia? I've read you have both government and private insurance.
Joie2009-04-07 17:38:26[QUOTE=Joie] TeedOff and Maz,
Often here in the US, folks lump together all countries that have universal care as being the same.
Your posts show that Canada's and Australia's health care systems are different. I know Canada is a single payer system, but is Australia? I've read you have both government and private insurance.
[/QUOTE]
It would be interesting to hear what LynNZ's input would be to this because Sandra has already posted her experience for the U.K.
Are you asking if Canada has private insurance or Australia, Joie?
Pat
Well, Canada has a single payer system, but then I think I've heard Canadians can also buy private insurance for some stuff. Is that correct?
And I think Australia has government and private insurance, but is it considered a single payer system?
Congress, our federal lawmakers, are working on health care reform. One thing being considered is offering a public (gov) plan that would compete with private insurance.
Since Australia has a system of government and private insurance and covers all its citizens, maybe a private/public system that would cover more people could work in the US too.
I realize no system is perfect, without its problems, but we have a lot of uninsured and underinsured folks in the US that have a hard time with health care expenses.
It costs every tax payer 1% of gross income for Medicare.
Now the government wants all of us to head down the private insurance tack, but they have penalised everyone over 31yrs of age as well. To take out private health insurance now it costs you more at 31 than at 30 and then on a sliding scale depending on your age when you take it out .... in other words if you are say 40 yrs old you will be a bigger premium than someone who is 35 yrs old.
WAIT WAIT!!! I've only read til page four......... but I have to ask NZ/Aussie/Canadians....
what about a med like enbrel....... that is EXPENSIVE!!! I could not afford to pay for it first.....then wait for reimbursement.......
what about biologics????
[QUOTE=Maz-aust]It costs every tax payer 1% of gross income for Medicare.
Now the government wants all of us to head down the private insurance tack, but they have penalised everyone over 31yrs of age as well. To take out private health insurance now it costs you more at 31 than at 30 and then on a sliding scale depending on your age when you take it out .... in other words if you are say 40 yrs old you will be a bigger premium than someone who is 35 yrs old.
[/QUOTE]
But that 1% levy doesn't cover the whole cost. The rest still comes from the taxpayers, even if it's not specifically called out on tax bills.
[QUOTE=leila]I don't mind paying for a portion of my drugs. What I do mind is my health insurance making seemingly arbitrary decisions about which drugs I can take without penalty.
I have migraines. If I choose to take a drug in the triptan class (non-addictive migraine abortive drugs such as Imitrex etc ) I have to pay damn near full price. The lowest cost drug was Relpax at 2 for SIX doses. If I want to take narcotic pain killers for my migraines, I pay for 30 doses. How much sense does that make?[/QUOTE]
exactly!!!
[QUOTE=JasmineRain]
But that 1% levy doesn't cover the whole cost. The rest still comes from the taxpayers, even if it's not specifically called out on tax bills.
[/QUOTE]
dead on, Jas.......
Am not privy to the government P & L's and I don't have a crystal ball so I don't know what our expenditure is on 'health' - my common sense agrees with you - but there are those that think every government has money trees in the backyard they call on ...
Of course everything that has government spending means they are spending our tax dollars .... of course it is our money!! I don't think Jas & Babs that we need to home in on that one.
This thread asked how much your meds cost you, and how you cope with the costs. This then has to take into account how your various governments treat health care.
I still find it disconcerting that it seems from your posts that USA insurance companies hold the key to what meds you can and can't get.
You don't know it's dead on as they haven't replied.
Maz - your entire surgery is going to cost you 0? What did Lynn's cost with her extravagant (compared to what we have) surgery cost? Lynn? All I know is 5 years ago, pre-RA and pre-diabetes, making us uninsurable in the future should he lose his job, our insurance cost us hardly anything. Now hubbys Fortune 500 company cut his benefits to the point that we're paying just under the amount to get any tax breaks.
[QUOTE=Maz-aust]Am not privy to the government P & L's and I don't have a crystal ball so I don't know what our expenditure is on 'health' - my common sense agrees with you - but there are those that think every government has money trees in the backyard they call on ...
That's true Maz. Those biologics - I have some questions there. If you can't afford your meds and you go for one of those patient assistance programs, who is picking up the tab? It's not the drug makers. Then, after a few years, who picks up the tab? It's the patient, right?
Pip
[QUOTE=Pip!]You don't know it's dead on as they haven't replied.
[/QUOTE]
I forgot we were to sit at the thread til an answer was posted.
IDK about anyone else's insurance..... but mine hasn't even blinked at having to pay for enbrel.....
AI members from many different countries have said how they've had to jump through hoops to get one or more of the biologics.
[/QUOTE]
Please show me one plan (public or private) that covers all medications, no questions asked.
[/QUOTE]
Actually, my insurance RX benefit has covered every prescription with no questions asked. I have a .00 or .00 co pay. They have to authorize, but to date have never questioned any of my meds, have never said I can't have a med, have never questioned my physicians. I realize how fortunate we are, but having this plan wasn't luck, it was 30 years of hard work. Lindy
anyone know how biologics go in any of those countries?
Canada, NZ, Australia, UK?
Lindy -
I see you're not with Medco.
And for the record, here's a breakdown of my meds, how many in a script/package, what the full price is, and what I pay:
Every day:
Hydroxychloroquine 60 ~ ~
Metoprolol 60 ~$ 5 ~$ 3
Fish oil 180 ~
(USD/month)
As needed:
Tramadol 60 ~ ~$ 5
Naproxen OTC 50 ~$ 4
Cetrizine OTC 60 ~
Hydro/APAP 30 ~ ~$ 5
Methylprednisolone (pak) 21 ~$ 6 ~$ 3
Amox/Clav 20 ~ ~$ 5
edit to apologize for formatting; fixed-width font/tabs not working as I intended
JasmineRain2009-04-07 21:11:27[QUOTE=JasmineRain]AI members from many different countries have said how they've had to jump through hoops to get one or more of the biologics. [/QUOTE]
my point, Jas... I'm not able right now to function without it...... bottom line....
I am not behind ANY government controled insurance .....
Well, Babs. It's been an hour since you asked, you must have stumped them otherwise they'd have answered you by now. Right Pip?[QUOTE=Pip!]Lindy -
I see you're not with Medco.
[/QUOTE]
I AM!!!!!!!!!!!!
stumped again?
I have Medco..... they ship me three months of enbrel for ........
what's your point, Pip?
No I don't have Medco. My RX benefits does use a national prescription company to disburse medications. They only dispense what my RX benefits approve and to date it's been all of my prescriptions. LindyMedco won't let me have my Minocin unless I pay 6 a month for that off patent drug.
well.. there you go...... you can't have minocin.... but I can have enbrel at thousands of dollars a shot......
wonder why??????????
Babs why on earth are you always so negative about everything ???
what's negative?..... I'm happy !!!
Maz. why do you interject YOUR negativity????
[QUOTE=Pip!]You don't know it's dead on as they haven't replied.
Maz - your entire surgery is going to cost you 0? What did Lynn's cost with her extravagant (compared to what we have) surgery cost? Lynn? All I know is 5 years ago, pre-RA and pre-diabetes, making us uninsurable in the future should he lose his job, our insurance cost us hardly anything. Now hubbys Fortune 500 company cut his benefits to the point that we're paying just under the amount to get any tax breaks.
[/QUOTE]
Yes - as I have health insurance it will cost me 0 out of pocket ---
If I didn't have health insurance it would have cost me ,800.
instead of attacking.
how about answer the questions posted in this thread?
instead of distracting from the REAL message, huh?
Oooh, now that's a huge difference.
Is anybody denied that extra insurance because of pre-existing conditions?
Pip
Babs - have you seen the orginal PBS video yet? I'm going to watch the last 15 minutes now.
Pip
well.let's see....... It's been 1 1/2 hours since my first question and almost 30 minutes since my last....
this is the same thing you all pulled on the APer thread ...... can't answer a real question...... but Im the negative one, ...........................right?
[QUOTE=Pip!]Babs - have you seen the orginal PBS video yet? I'm going to watch the last 15 minutes now.
Pip
[/QUOTE]
actually no..... ms. thread drifter and question avoider....
I've been in florida! it's on my TV at HOME
I did answer the questions asked of me Babs and I am really happy for you that you can get your meds at a reasonable cost to you !!
Babs - she's answered all the questions you've asked, I believe. The others are probably asleep.
tell you what......
I'm going to bed.........
You have all night to answer these questions......
thanks all...... sweet dreams.
[QUOTE=babs10]anyone know how biologics go in any of those countries?
[QUOTE=Pip!]Oooh, now that's a huge difference.
Is anybody denied that extra insurance because of pre-existing conditions?
Pip
[/QUOTE]
From the date you join a health insurer you have 12 mths for a pre-existing condition, after then all is covered....
I know Pin had problems in the UK. Something to do with if you failed two meds then you weren't eligible for more. I don't know if they do that for older DMARDS. Boney was a UKer and he's gone too. Pin also said people were protesting that...no idea what the results were.
As for Canada, NZ, and Australia - we'll have to wait for the others to weigh in.
[QUOTE=JasmineRain] [QUOTE=babs10]anyone know how biologics go in any of those countries?
Canada, NZ, Australia, UK?
[/QUOTE]
Here's her question
[/QUOTE]
Thanks Jasmine,
But as I don't use biologics myself and don't know anyone who does I don't have any idea.
Maz - did you see Jas's question?[QUOTE=Linncn]Well, Babs. It's been an hour since you asked, you must have stumped them otherwise they'd have answered you by now. Right Pip?[/QUOTE]
Are you referring to me? If you are I have other things in my life to do besides sit and answer dumb questions. IF you were the LEAST BIT INTERESTED and really were interested in the answers, I would be most obliging to get the answers for you if I didn't have them but you all have your heads so firmly entrenched in cement it is so obvious all you want to do is argue. I have no intentions of carrying this on any further. This is nothing but a dumb game to you and to hell about the people who really want to know. If someone has a serious question then by all means ask away.
TeedOff2009-04-07 21:50:18Can you find somebody? Seriously - this is an important question.Pip if you give me a couple of names of biologics I can find out ....
Hi Pat - didn't know you were still up!
I really would like to know. Does Canada have a two drug minimum like the UK?
Enbrel
Humira
Orencia
Rituxan
Remicade
Anything on a government website?
[QUOTE=Pip!]Hi Pat - didn't know you were still up!
I really would like to know. Does Canada have a two drug minimum like the UK?
[/QUOTE]
Hi Pip
Just logged back on after having dindin and a visit from friend from Blythe.
Not that I am aware of but I will ask tomorrow, but I sure am not going to spend my valuable time with my Dr. researching for somebody who doesn't appreciate it anyway.
I can't see that happening as dh has an ongoing drug he is on and yet he can get other medications if need be.
[QUOTE=Pip!]I know Pin had problems in the UK. Something to do with if you failed two meds then you weren't eligible for more. I don't know if they do that for older DMARDS. Boney was a UKer and he's gone too. Pin also said people were protesting that...no idea what the results were.
Biological DMARDs
target pro-inflammatory cytokines that are involved in joint
destruction, in particular tumour necrosis factor alpha (TNF-alpha) and
interleukin-1 (IL-1).[5]
There are 4 biological DMARDs available in Australia — etanercept,
infliximab and adalimumab (TNF-alpha inhibitors), and anakinra (IL-1
receptor antagonist).
Where do they fit?
Systematic reviews of randomised controlled trials have shown a
large effect of biological DMARDs on disease activity compared with
placebo.[19–23] This is mainly in patients with severe disease who have not responded to at least one conventional DMARD.[19–23] Combining treatment with methotrexate provides greater efficacy compared with methotrexate alone.[19–23]
There is no direct evidence from randomised controlled trials that
biological DMARDs differ in their efficacy. Indirect comparisons
suggest that etanercept, infliximab and adalimumab have similar
effectiveness, while anakinra may be less effective.[19,23] Choice of treatment depends on patient preference.[24]
Biological DMARDs are generally well tolerated[19–23], but some patients may stop treatment due to adverse effects (e.g. injection site reactions).
PBS eligibility
The PBS listing
for biological DMARDs reflects their place in therapy. Patients are
only subsidised if they have severe disease (e.g. at least 20 affected
joints) and do not respond to, or cannot tolerate, conventional DMARDs.
- Only 1 biological DMARD is subsidised per patient at any one time
- 4 drug choices are available to be prescribed in each treatment cycle
- Patients receive subsidised treatment while they continue to show a response (defined in the PBS restriction)
- Patients
may switch to another drug (e.g. because of adverse effects) without
having to experience disease flare to re-qualify for treatment
- If there is an inadequate response to 1 drug, it cannot be re-prescribed within the same treatment cycle
- If there is an inadequate response to 3 drugs, patients may not enter another treatment cycle for 5 years
TEED~ Uh, no. I wasn't referring to you. [QUOTE=Pip!]You don't know it's dead on as they haven't replied.
Maz - your entire surgery is going to cost you 0? What did Lynn's cost with her extravagant (compared to what we have) surgery cost? Lynn? All I know is 5 years ago, pre-RA and pre-diabetes, making us uninsurable in the future should he lose his job, our insurance cost us hardly anything. Now hubbys Fortune 500 company cut his benefits to the point that we're paying just under the amount to get any tax breaks.
[/QUOTE]
I had a different insurance plan 7 1/2 years ago Pip. It was an 80/20 plan. And I also had a pretty extensive surgery and in hospital stay....No offense, but I hardly think the two operations can be compared.
My insurance now may seem extravagant to you, but my DH has worked very hard for 34 years to receive the perks that he has...And yes, I consider our "extravagant" insurance to be one of those perks........along with stock options, a pension plan and a 401K
Reason as to why Minocin may not be available to Pip and why Enbrel is not an issue (Babs asked) This response is based on BCBS formulary list. Medco or other Pharmacy companies could be different. Minocin is a non-formulary med. If the plan has a closed formulary, that means higher cost to patient if you don't use generic or brand. Enbrel is brand med, so not an issue. If your plan is open formulary, you can usally receive non-formulary meds, but at a higher copay. Interesting thread.
Just so everyone knows.....I dont sit at the computer waiting for a question pertaining to NZ.
I have a life away from the PC.
Now y'all are gonna have to wait re biologics costs here in NZ, but I can say that my Rheumy told me they cost a fortune. I will try to find out costs and how/if they are funded tomorrow. Maybe, as it will be a frantic day at my kitchen given its the day before Good Friday.
Lyn
ETA:
LyndeeNZ2009-04-08 04:02:54
[QUOTE=LyndeeNZ]Just so everyone knows.....I dont sit at the computer waiting for a question pertaining to NZ.
[QUOTE=Linncn]TEED~ Uh, no. I wasn't referring to you. [/QUOTE]
nor was I, Teed........ I think you know I'm not playing games.......thanks for your info
[QUOTE=Maz-aust]Pip if you give me a couple of names of biologics I can find out ....
[/QUOTE] thanks for your efforts, Mazthanks, Jas!!
I don't see positives in those plans for biologic use........ either I don't understand or it isn't specific about payment.
American doctors won't be happy losing control over patient care and being restricted.Nor will I for that matter!!
Ladies and Gents..... I think it s a long long way off before we get a health care plan..... there are so many parameters and lines to be drawn that it will take a LONG long time before it comes...... I can hope
[QUOTE=babs10]thanks, Jas!!
IDK if my RD had to jump hoops or not......he gave me the script...... I took it same day to the pharma... at the time of our appointment, he didnt' know which biologic I was going to choose...and he gave me three or four options......
I do have an excellent med plan... a PPO of BCBS....considering I've hardly used previous plans I am grateful that my position gives me this excellent insurance... and like Lynn49... I worked my butt to get where I am for this..... and I could have settled for the HMO.. but I pay premium premiums to have this better insurance....
We won't have that option w/ a government plan.
I'm a libertarian at heart.... I want less government... not more... so this grates on me no matter what.
[QUOTE=babs10]IDK if my RD had to jump hoops or not......he gave me the script...... I took it same day to the pharma... at the time of our appointment, he didnt' know which biologic I was going to choose...and he gave me three or four options......[/QUOTE]
And chances are, your benefits provider looked over your records and saw what other therapies you had already tried. Maybe your doc had even already pre-certified you for a biologic (even if the specific drug hadn't yet been chosen). I doubt that you could just get a script for one of these meds filled with no prior data.of course they had all my previous meds.. it was the same insurance co....... just saying I did nothing for precert... though RD may have.My dad worked for 41 years to get health insurance for him and my mom (and us when we were kids). It was supposed to be there until they were both dead. It's not. In order to cut costs they cut the retiree's benefits to about half of what they were. Which is not nearly as bad as United Airlines, and other Fortune 500 companies, who bailed out totally of what they 'promised/guaranteed' their workers and dumped them on the government for 1/3 of what they worked for all their lives.
I guess a guarantee is only as good as how much the CEO/Senior Vice Presidents want to take home with those obscenely generous bonus packages, signing bonuses etc. I mean, they have a standard of living they must keep. Their people, who they abandoned, get the dole, I guess.
Pip
[QUOTE=Pip!]My dad worked for 41 years to get health insurance for him and my mom (and us when we were kids). It was supposed to be there until they were both dead. It's not. In order to cut costs they cut the retiree's benefits to about half of what they were. Which is not nearly as bad as United Airlines, and other Fortune 500 companies, who bailed out totally of what they 'promised/guaranteed' their workers and dumped them on the government for 1/3 of what they worked for all their lives.
[QUOTE=Pip!]Hi Pat - didn't know you were still up!
CRITERIA FOR INITIAL TWELVE WEEKS OF COVERAGE FOR ADALIMUMAB
Note: Initial coverage is provided for 12 weeks of 40mg every other week of adalimumab ONLY.
-Prescribed by a rheumatologist AND
-To be used for the treatment of severely active rheumatoid arthritis OR
-To be used to treat severely active rheumatoid arthritis in patients who are intolerant or has contraindications
to methotrexate (see below)
Patient is refractory to:
-Methotrexate: oral therapy at 20mg or greater total weekly dosage (15mg or greater if patient is <65
years of age