Here's a Medicare D "WTF?!"

[madamesilverspurs]

I just went to pick up my meds at the pharmacy. The doctor had ordered a change in dosage on one of them, as taking it twice a day in a smaller dose is more effective than taking it just once a day in the larger dose.

Medicare D, however, will only pay for the one-per-day pill. It isn't available as a generic, and it has a hard shell that doesn't permit it to be cut equally in half. The pharmacist just shook his head when I asked if it made sense to him.

Criminy.

[hedgehog]

1. Doctors just go to 4 years of undergraduate study, followed by three years of medical school

followed by 2 to 5 years as intern/resident and ongoing continuing study. Why should they know more about medicine than a clerk at the insurance company?

[notesdev]

3. That's not the insurance company

That's a government bureaucrat making that decision. And no, they don't know more about medicine than a doctor, either.

If neither party was involved, health care would be cheap and plentiful.

[TahitiNut]

4. Wrong. Medicare Part D is entirely private ... corporate plans each with narrow benefits.

That's the problem with Medicare Part D ... it's effectively unregulated and there is NO 'standard'. Big Pharma and corporate drug store chains and others have cobbled together the very narrow and drug-specific plans that are all designed to have narrow advantages and lots of loopholes. Just in the drugs covered, they all vary ENORMOUSLY. It's virtually impossible to intelligently select a Part D Provider without knowing, in detail, the specific drugs one requires. Thus, one cannot reasonably select a plan/provider ahead of time.

It's an ENORMOUS clusterfuck. They're designed to get federal subsidies and have very narrow and limited coverage.

The only part that's 'government' is how it's paid. The beneficiary pays about 25% of the premium and the rest is paid by the 'HI' funds.

[Oregone]

5. "If neither party was involved, health care would be cheap and plentiful."

Yes, the magic free market is known to bestow its gushy goodness on us so often.

For profit, magic market, health care will always be the most profitable way to provide X% of the people care at the gross profits of Y.

If Y is maximized well above any reasonable cost for the actual service when X = 10%, then so be it. Hurray free market.

[kickysnana]

2. There is an appeal process but I assume your pharmacist already tried that. n/t

[rucky]

6. Can the Pharmacist cut the generics in half for you?

kind of like a butcher making a custom cut?

[madamesilverspurs]

7. No generic available.

And the literature on the drug advises against cutting the pills, so the pharmacist isn't likely to do it.