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Sad State but Reality

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  • Sad State but Reality

    I am posting this to make everyone aware of the state of affairs here in the U.S. (and perhaps make others aware of what they truly have). I had a 13 year old patient today with Multiple Sclerosis who was prescribed Enbrel from our specialist Children's Hospital. This particular family has a pharmacy benefit plan in which they must pay a 20% coinsurance for self-injectables. This has been a change for many after January 1st. Patient was to take weekly injection for which she came into the office (and caused another copay for an office visit). The mother of the child was just told that she had to pay $250 U.S. for 1 month's worth based upon her plan (approx 125 GBP). Child needs it, mom can't afford it. Maybe some help from the drug company at this point, but I wouldn't bet the house on it. This is a very sad state, but a reality here in the U.S. I have 2 children of my own and I can't imagine this. It made me sick to my stomach to relay this information and know that there was absolutely nothing I could do about it since it was a "benefits" issue. This is also a huge problem with our geriatric population who are often times on an average of 7-8 medications. Some must decide to use the pension/social security on their medication or mortgage. This is the reality here in the U.S. and it's only getting worse as drugs become more expensive and the population ages. I don't know much about the UK system, but I bet it's better than this! Oh and we pay proportionally the same amount of taxes too! My wife is from Spain and this is not even a conceivable concern there.

  • #2
    Re: Sad State but Reality

    Have always said we do not know how lucky we are here in the UK when you read letters like this, and that from the land of the free. Presumably that includes the right to needless death too.

    It makes the abuse of the system by UK patients and medical staff I see on a daily basis all the more unforgiveable. Literally sickening in fact.

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    • #3
      Re: Sad State but Reality

      The land of the "free" would be the biggest overstatement of the century! I had another one today. Lady whose A1c was up from 7.4% to 9.6% in a matter of 4 months. She actually lost weight, so couldn't explain by diet. On max dose metformin and needed a sulfonylurea such as glipizide. However, one problem: she hasn't been monitoring her home blood sugars because SHE COULDN'T AFFORD THE TEST STRIPS. She was very motivated to take care of herself, but for obvious patient safety issues, have to hold off on the glipizide until she can monitor. We are trying to help her out, but just another example of someone that slips through the cracks and ultimately ends up costing the healthcare system here more money downstream. Unfortunately, this kind of thing happens far too often....

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      • #4
        Re: Sad State but Reality

        Here in UK we have several pts with two monitors and upto 8 packs of strips.
        When pts questioned one replied that wanted to check if both monitors gave same reading. He was testing upto 13 x a day. UK spends more on strips than on antidiabetic drugs. Pts of course have no idea of cost. Gillette had the idea -- give away the razors and sell the blades. Monitors are sold very cheaply as not provided by NHS. Many bought by pts for overseas parents.

        Many UK pts living overseas give their children's addresses as residence to a Dr and return to UK to pick up rpts. Surprised that 'accomodation' addresses not yet set up to enable USA pts to benefit. Already UK childs benefits based on UK cost of living are being sent back to Poland.

        Have already dispensed NHS scripts where address given is overseas.
        johnep

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        • #5
          Re: Sad State but Reality

          Originally posted by johnep View Post

          Have already dispensed NHS scripts where address given is overseas.
          johnep
          Conniving at fraud then, Johnep? The Counter Fraud people will be after you as well!

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          • #6
            Re: Sad State but Reality

            Originally posted by johnep View Post
            Here in UK we have several pts with two monitors and upto 8 packs of strips.
            When pts questioned one replied that wanted to check if both monitors gave same reading. He was testing upto 13 x a day. UK spends more on strips than on antidiabetic drugs. Pts of course have no idea of cost. Gillette had the idea -- give away the razors and sell the blades. Monitors are sold very cheaply as not provided by NHS. Many bought by pts for overseas parents.

            Many UK pts living overseas give their children's addresses as residence to a Dr and return to UK to pick up rpts. Surprised that 'accomodation' addresses not yet set up to enable USA pts to benefit. Already UK childs benefits based on UK cost of living are being sent back to Poland.

            Have already dispensed NHS scripts where address given is overseas.
            johnep
            That happens sometimes here as well, although mostly from state to state. Here, many organizations give the monitors to the pts for free, and they make their money on the strips. That is very common here. Our organization allows pts to obtain 1 monitor per year if needed. If pts move away and the organization knows about it, they usually sever the relationship in terms of obtaining benefits through pharmacy. Another common practice here is that no matter what the pt's benefit structure is (and they are exponentially different), the cash price is included in small print on the pt handout. So, if they pay $10 for a generic medication, it may have $110 in parentheses as well. I like this idea, but unfortunately it doesn't seem to confer a gain in appreciation of what benefit they have.

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            • #7
              Re: Sad State but Reality

              Originally posted by the old merlin View Post
              Conniving at fraud then, Johnep? The Counter Fraud people will be after you as well!
              I've dispensed NHS scripts for patients whose address was stated as "Germany"... Why would this be conniving at fraud, then?
              I thought that's what the reciprocal agreements regarding healthcare within the EU were about: if a german holidaymaker needs medical care urgently, he/she gets treated in the same manner as a national of the country he/she is visiting, so why couldn't he/she get an NHS script dispensed?
              Ze genuine Article, present & perfect!

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              • #8
                Re: Sad State but Reality

                THe trouble with reciprocal benefits is that the purchasing power is related to the cost of living in that country. EU nationals receiving UK benefits can send the money back to a country where they may be greater than local wages.

                Great inducement to fraud.
                johnep

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