Step 1: Nationalize all healthcare under a public single payer system. Step 2: ??? Step 3: Never profit again.
Death panels
Wait… I thought that was only supposed to happen if we had socialized medicine.
(Duhh)
The system is so ass backwards now. I was just talking to a retiree who said his first claim denial resulted with him getting a lawyer and now its been 4 years of just some law office letting him know he got approved for another prescription. The costs are all between medicaid, the insurerer and probably some dumbass in the government or insurance admin who just rubberstamps claims and checks.
Well yeah, Trump rewards this
There are a number of variables here, only a few of which were touched on in the article. Health plans are battling big pharma. You may see an increase in denials, but there has also been a huge increase in health plan spending over the years due to medication prices. The article does mention that some of the denials are admin issues and not necessarily an outright medication denial (duplicate claims) and in some cases the patient is provided a cheaper biosimilar.
We’re missing data about which medications are being denied and why, a chunk of which could be due to the rise in diabetes medication like Ozempic being used for recreational weight loss.
Yes, health plans can do more to help patients, but big pharma can do A LOT more to help patients and we are on track for that with medication related pieces of the IRA from Biden. We’ll see if it’s blown up.
From personal experience, frivolous denials are way up. Having to appeal regular covered care at a significantly higher rate than last year, during which I had a single appeal necessary. This isn’t just insurance fighting pharma, it’s also them trying to bleed people dry by using illegitimate denials to drive up profits.
It’s both and one exacerbates the other
due to medication prices
There’s no reason for medication prices to be as high as they are, though. Look at the prices in practically any other developed country.
I’m from Australia which uses a single payer system (meaning the government negotiates medication prices for the entire country and buys them in bulk) and some medications are literally 5-10x the cost in the USA compared to Australia.
medication like Ozempic being used for recreational weight loss.
There’s a variant of Ozempic called Wegovy that’s used for weight loss. That’s what it’s designed and marketed for.
Yeah the base prices set by pharmaceutical companies is the main problem.
Didn’t know about Wegovy. It’s the same thing as Ozempic. Is it cheaper?
My wife has weight issues that effect her health. Here is the thing. She has low thyroid and her tests come out as just within normal on the low side. She has other symptoms of low thyroid with hair and such and her doctor refuses to up her relatively cheap thyroid medication dosage (which we have to pay for anyway) and instead has her on ozempic. I firmly suspect shannigans like what caused the opiod epidemic. I see no reason this doctor is so adamant about using ozempic without some sort of quid pro quo. Pisses me off.
Sorry to hear that. Hope your wife gets the treatment she needs. Yeah, there are laws to prevent direct payments but there are other ways providers can benefit from prescribing specific meds. You don’t have a billion dollar industry without breaking/getting around some rules.
