Cost of meds in the US

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Samkl

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A few posters have mentioned the cost of pharmaceuticals in the US, and I’m trying to compare to the situation here in Oz. For example I’m on blood pressure meds and they cost about $12.00 a month (about $US8). I’ve investigated for my brother the possibility of “off label” Triumeq (repurposed anti retroviral med currently used to treat HIV) which is in trial for ALS atm (the Lighthouse trial). An “off label” script (because it’s not for treatment of HIV) would cost about $A800, but for HIV patients, because out PBS has licenced it for that treatment, would be about the same as my blood pressure meds, or not much more. How does it work in the US? Interesting that some have suggested a neuro may be able to prescribe a med “off label”. Does that mean you can get, say, Triumeq at a reasonable price?
 

Nikki J

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In the US usually the very expensive stuff even if it is on the formulary for your insurance requires what is known as a PA which means prior authorization.

as an example Nuedexta needs a PA for my insurance. If my doctor prescribed it she would then be sent a form to fill out that woould ask about my symptoms and diagnosis. In your example they would likely require copies of various blood tests that relate to HIV

the insurance companies can and do deny coverage if you don’t meet the standards. It is possible to appeal but an investigational use is unlikely to be covered

in addition even for covered meds there are different tiers with private insurance. With Medicare which many PALS have it is even more complicated but expensive drugs end up being very expensive for patients especially as the year progresses
 

Samkl

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Once something is approved by the Pharmaceutical benefits scheme (PBS) it’s pricing is then largely standardised if you’re are prescribed the med for the condition it is approved for (my example re Triumeq)
 

Samkl

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Do you have an overarching medical scheme like Australia’s Medicare? (citizens are automatically covered and we pay approx 1.5% a year in tax to pay for it)
 

Nikki J

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No. our system has multiple companies and the governments covering different populations. If you are really interested there is plenty to read online as it is a major political issue. However your head will likely explode 😀
 

KimT

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Nikki is right. Each State is different. Premiums differ amount classes or groups. Inadequate coverage for home health in most states. I live in one of the more backward states (Florida). Good thing I have to leave or I'd go on a rant. Maybe tonight.
 

Nikki J

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More than just every state. Most people non elderly , poor or disabled, either get insurance through their work or buy private insurance with or without help from the government and not only are there many private companies there are multiple plans within that company that have different rules and benefits
 

Clearwater AL

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Just a different note.... just few years ago to sponsor a NASCAR stock car for a full
season took $35 million dollars. It's got to be even more today.

Do these drug companies have that much money to do that and run millions of
dollars of TV ads too? And... spend millions of dollars lobbying our best money
can buy politicians.

Sompin' ain't right here.
 

affected

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You really can't compare our health system with the US - none of the terms even really mean the same thing, like medicare and health insurance and palliative care. I had no idea about any of this until talking here on this forum years ago when navigating things for my Chris.
We also have the health care card which on top of the PBS means that any script is only a very small cost no matter what it is, and bulk billing which a doctor may or may not elect to do regardless of a health care card.
We are SO lucky with our system here, imperfect as it is.
 

Samkl

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In watching the Democratic Presidential race from afar, I must say it’s astonishing to see “Medicare for all” framed by Republicans, and maybe some Democrats, as “socialist”. Perhaps it is, but the right side of politics tends to conflate “socialist” and “communist”.
We always remind our children that they are the luckiest people in a very lucky country, and decent healthcare as a right is a big part of that. Sorry to appear to bring up “politics”, if that’s what it is, but I find myself becoming increasingly distressed on hearing people not getting what they need when they need it due to benchmarks, levels of cover etc. in the US. And if ever you need the bean counters to back off, it’s when you get an ALS diagnosis.
You’re right Tillie, our system is not perfect, but it really needs to be defended against the free market and privatising forces that seek to monetise, even people’ suffering.
Ok, I’m off my soapbox, and am slinking away😏
 
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