Most insurance plans requiring patients to “fail first” on cheap meds.
 

Patients who for years have taken medications approved by the Food and Drug Administration to relieve their diabetic peripheral neuropathy are now being forced by their insurers to fail first on outdated drug regimens which aren’t even FDA-approved to treat their condition.

http://m.northwestgeorgianews.com/ro....html?mode=jqm

Also known as "step" and "tier" programs designed to get everyone on the same cheap (and many outdated) drugs and routinely deny coverage of more commonly prescribed drugs just to save the company money.

Yes, they do this now commonly.

The Tier function has been around for about a decade now on many drug therapies.
It also has been in place for blood pressure medications, and I would expect it to be in place for the biological treatments like IVIG, Humira, etc.

I understand insurance companies and their partners want to save money by recommending cheap if not dated alternatives but their multiple tier programs keep many helpful drugs out of reach for patients thereby compromising quality care.

So True.........This happened to John when he was in the hospital for treatment for his bone marrow failure. They had to use an older IV anti-fungal which was very hard on the kidneys. They would not allow them to give him the newer formulation that was easier on him until they could show harm from the older medicine. He was so compromised from everything going on and they would not authorize a better, less damaging medicine until his kidneys were effected.

Beatle...thanks for posting the article.

It is truly criminal that the insurance companies can get away with it.
Our legislators don't care because they have their own health care insurance.

Best thing we can do, especially with elections next year....send the article to your local politicians and tell them it is not fair and to fix it...if enough people do it, it may make a difference. We need to put our cynicism and frustrations with our legislators aside for a day and try it. If every American who sees this post contacted their officials, it may make a dent.

Click on this to find your politician, just enter zip and in 2 seconds you can email them the article.

https://www.opencongress.org/people/zipcodelookup

Thanks, D.

Thanks Diandra!

My company's insurance plan is through United Healthcare. They, like many insurance companies have had a tier system in place for years but theirs is now a 3-tier system (through their horrible partner, OptumRx) containing most brands. They force patients to first try three drugs solely due to their low cost and even then will frequently deny coverage, making it as hard as possible on the patient and prescribing physician. In my case, my doctor called, wrote letters, as have I to explain that I am sensitive to medications and cannot tolerate most due to side effects. They do not care.

I think your suggestion is good, to contact our lawmakers and our company's administrator is shopping plans right now so we can switch to one that covers prescriptions as written.

Well, I look at it this way, the older drugs have more long term use & info behind them, while the newer ones may have issues after long term.. this is just what is learned over time .. so it actually might be a good thing..

Newer is not always better..

Newer is definitely not always better but I have tried newer, older and in between and hydrocodone ER works best for me with the fewest side effects.

And of course Big Pharma has a vested interest in wanting to convince us that the newer drugs are better, even when making just minute changes to the old so the patent expiration no longer applies.

I'd always opt for an older and well-tested med before trying a new one...both from a cost and safety standpoint.

That's not to say that some newer meds aren't better and lifesavers, though.

I too would prefer to lean towards an older med but after pretty much trying everything, I've had the best results with this drug (which happens to be on the newer list) and the side effects are tolerable.

Hi beatle,

Thanks for this thread.

I went through almost EVERY generic pill on the market for a particular condition and none worked. Finally, I was put on a BRAND name and it worked perfectly.

My insurance "allows" it ONLY because I have proven over years of taking the generics with lab results PROVING the generics did not work and the brand did. BUT, they pay very little on it and I have to pick up most of the tab. Do they really think I prefer to pay out of my pocket $98 each month for the brand name drug if I would only pay about $9 for the generic?

Almost monthly, I get a letter in the mail from my insurance company "alerting" me to the availability of the generics for this medical condition and suggesting that I change to the generic.

I take 14 meds, and 4 of them are BRAND name drugs as I have tried the generics and did not get the results needed. My insurance sends me letters suggesting I switch to the generic on 3 of the 4 brand name drugs. I guess I will soon hear about the 4th one.

Technically, there shouldnt be any different in formulation between a brand and a generic, but the packaging could be differe. The generic version carries food coloring, which could cause allergies, and fillers, which the brand name doesnt have.
the insurance will no way pay for something that cost 98$ or hundreds of dollars when theres a generic involve

What I don't understand is why the prices don't come down on the brand once generics are on the market since they now have competition. But even generics have increased in price lately. I've read there's now less competition amongst the makers of the generics which allows them to up prices. Too many mergers perhaps?

Patent
 

There are NO generics with the same formulation for brand name drugs that are still under patent. That is the whole purpose of the patent. It is only once the patent has expired that generics are marketed with the same formulation.

However, there are "different" drugs that are used for a particular medical condition.

Let's use anti-hypertensives as an example. There are various classes of them. Beta-blockers, ace inhibitors, calcium channel blockers, etc. They all treat hypertension but each class has a different action and formulation.

If a NEW anti-hypertensive in a particular class of them is made and patented, there are generics on the market, but they do not have the same formulation as the new drug under patent. So, yes, there are other drugs that treat the medical condition but may not be effective for the patient. If they were all the same, everyone with hypertension would take the same "generic" drug.

There are generics that are used for some of my medical conditions but I am taking a brand name patented medicine for some medical conditions that do indeed have different formulations from the generics on the market that also treat some of my conditions. I DO take many generics that work for some of my conditions but I also take some patented drugs for which there is no generic on the market that produces the same results.

I am sorry if I did not make that clear in my post.

I did not say the drug "costs" $98, ..... the drug costs much more. The $98 is the amount for MY portion, not including what the insurance pays on it.

My point was it would be foolish of me to pay $98 out of my own pocket if there were another drug that gave me the same results for which I would only pay $9. Does my insurance company think I am that stupid?

They keep suggesting that I take other drugs that I have already tried and did NOT work.

I use the medical establishment very carefully now. They mostly are not my friends and could care less about me unless I don't pay the bill. That's a reality that should send folk searching elsewhere for answers. I have found most of the things I'm using successfully doing internet searches.