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Medicare Tries An Experiment To Fight Perverse Incentives To Prescribe High Cost Drugs When Similar Less Costly Meds Do The Same Thing ?

Medicare Tries An Experiment To Fight Perverse Incentives To Prescribe High Cost Drugs When Similar Less Costly Meds Do The Same Thing ?

Suppose you’re an eye doctor and you’re treating a patient with macular degeneration, a disease that can cause blindness. You have the choice of giving one of two drugs — one that costs $2,000 per treatment and another, very similar one, which costs $50 per treatment.

Do you think it would influence your decision if you were paid $117 more if you chose the more expensive drug?

That, essentially, is the system we have now.

For doctors who give drugs in their offices, mostly cancer, eye and… read more

A MyParkinsonsTeam Member said:

This will be a long response.
I've been a pharmacy technician for 12 years and my best advice to patients is to get to know their insurance plan's drug formulary. Most are tiered in that your co-payments will very greatly depending on which tier it is in. Your formulary is based on decisions made by your employer with the insurance company. When insurance contracts are up for renewal, many times that is when you see a change in your company's coverage and/or insurance company altogether. Insurance companies also contract with pharmacies. So there are preferred and non-preferred pharmacies. This also affects your co-pay. If your company offers mail order prescription, it will be the least costly way to fill. If you need to fill a prescription locally, such as cold medication, your insurance will offer lower payments for those Rx's in a preferred pharmacy. Another way to lower costs is that many "new" drugs that are offered in brand only, are actually reformulated by putting together two drugs that where previously separate and are offered generically. This enables the pharmaceutical companies to continue to make higher profits on the same drugs. Ask your doctor to give you the separate generic versions. Also, be aware that when doctors give you samples for free, those samples came from a pharmaceutical representative who is paid to "educate" doctors on the latest available medicines. When you start a new medicine this way it is advisable you do research before starting it. You may find a comparable generic that will be much less costly for the long haul. Also if the doctor gives "coupon" cards- same thing. These are all gimics from the pharmaceutical companies. Even if the doctor insists on giving you the prescription, you can always have your pharmacy put it on "file" for now until you've made up your mind. You have to be PRO active in your healthcare or pay the price, literally.

posted over 5 years ago
A MyParkinsonsTeam Member said:

About 6 years ago before my PD diagnosis, my doctor had me try an expensive SSRI (Vibryyd) the drug company had left samples of. It worked wonders and had less side effects than the Lexapro and Celexa I had previously tried. Once the free trial was over, obviously I was hooked. It doesn't have a generic equivalent and is a very expensive drug. I am lucky to have good insurance, but what if I didnt? Did my dr give it to me because there was an incentive? My guess is yes, and this ticks me off.

posted over 5 years ago
A MyParkinsonsTeam Member said:

i have known this for a long time. our insurance always gives us generic unless we r allergic to generic. this is very, very sad; however the big oharms and drs. and politics own this country. Hopefully next Pres. will help. We all need to think about our choice.

posted over 5 years ago
A MyParkinsonsTeam Member said:

If you trust your doctor stick with them I know she always says check with the pharmacist there may be a cheaper brand, if she wants you have the other for a particular reason she always attachs a note to the prescription and they will give that brand otherwise I use the genertic brand but a pensioner of here always pays a set price ubless it is something not on the "Free"list be guided by your doctor

posted over 5 years ago
A MyParkinsonsTeam Member said:

I still have insurance coverage through my job. The insurance company is very quick to question prescriptions for higher cost drugs. In fact, they have recently reduced their list of covered drugs eliminating a very successful diabetes drug my husband was using. This kind of oversight by the insurance company has the benefit of encouraging the use of equally effective, lower cost and/or generic drugs. But it does mean that we have to scramble somewhat to make adjustments depending on which drugs are still on the approved list. I am, however, very grateful for the prescription coverage given the number and cost of drugs my husband needs.

@A MyParkinsonsTeam Member, what is Medicare going to do about these incentives? Eliminate them? What do we as consumers need to know and what can we do?

posted over 5 years ago
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