Tuesday, September 20, 2016

Something is broken, but it's not my foot

Peroneal tendonitis. That's a fancy word for "you twisted your foot and it won't get better if you insist on wearing flip-flops and ballet flats." After weeks of a mildly annoying achy foot, and an x-ray to rule out a stress fracture, that was the podiatrist's diagnosis. Treatment: a lecture on proper footwear and a prescription anti-inflammatory for a month while it heals.




And that's where the real problem started. The doctor prescribed a pill called Vimovo, twice a day. She gave me a few samples and said she was calling it in to a pharmacy in Acworth (I was in Midtown) that would mail me the 30-day supply. She said it was like Aleve, but wouldn't upset my stomach to take twice a day.

I've had issues before where an allergy doctor prescribed me a really expensive version of Flonase that wasn't covered by my insurance, so when I got back to the office, I went on to my health insurance website to check the coverage. 

Vimovo is not covered. And a 30-day supply of this wonder drug from a mail order pharmacy would cost me $1,916.98, according to my insurance company. Holy crap! So I called the insurance company to verify. Yep, it's not covered. Then I looked up Vimovo find out what was so great about this insanely expensive little pill. And you know what, it's not just "like Aleve." It IS Aleve. TWO THOUSAND DOLLARS FOR ALEVE, WITH A COATING OF NEXIUM! 

So I called the pharmacy to cancel the prescription, because just hell no. The pharmacist tells me that they have a partnership with the company that makes Vimovo, and that I'll only have to pay $10 and the manufacturer absorbs what my insurance doesn't cover. What kind of bullshit is this?!?!? Now I'm sure that Horizon Pharma isn't taking a massive loss out of concern for my health - you can bet that they are probably making a profit on the drug at the $10 cost, which comes out to 6 cents per pill (and trying to get the remaining $1906 (or at least part of it) from SOMEBODY.  Probably my insurance company, who will then try to get it from me, or bitch about high costs and raise my/my firm's rates.  

To compare: the Vimovo pill would cost somebody who actually has to pay the market price about $64 per day for the month I need to take it. If I go to CVS and buy large-size bottles of generic aleve and prilosec (cheaper version of Nexium), I can take the exact same dosage of the same meds for about $1.20 per day.

I also found this New York Times article about Horizon, which bought the patent on the Vimovo from Astra Zeneca and  upped the price about by 1200% over a two-year period. Their other big money drug is a similarly overpriced combo of motrin and pepcid. And the company isn't run by PT Barnum, although CEO Timothy Welbert probably shares Barnum's views on the rate of stupidity among American consumers.

Now when it comes to my health, I'll admit I've been pretty lucky so far (sound effect= one very loud knock on wood). Heading into middle age, I've had very few problems, I've have always been fortunate enough to have very good health insurance coverage, and like to think I'm reasonably intelligent enough to do the research about procedures, drugs and costs.

But you know what, I'm pretty sure I'm in the minority, and that lots of people are getting really screwed over by greedy pharmaceutical companies, greedy insurance companies, or doctors and pharmacies who are probably getting all sorts of kickbacks and fancy lunches for prescribing this stuff. 

We need to admit that the system is broken. We need to admit that we can do better. We need to look at most other industrialized countries who have some form of a national health system and have lower costs and better health outcomes (better mortality rates, lower disease rates, higher quality of care,etc.).

But for now, I'm  going to do the only three things I can do: vote for politicians who want to see the system change, stop by CVS on the way home, and buy a new pair of Sketchers.

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