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surnik22 t1_j0yb1og wrote

Reply to comment by Sybertron in Molecule that mimics insulin opens new doors for a diabetes pill by rchaudhary

Insurance will cover it if it is cheaper than expected long term costs of not having the shot. Paying $10k a year (after you pay the first $5k deductible of course) is lot cheaper than paying for long hospital stays, limb amputations, and other infection related issues.

I’m sure the companies making the shot will set the price to just below the calculated long term costs of not getting the shot.

That’s the “joy” of privatized medicine. Pharma companies set high prices, to suck as much money from insurance as they can. Hospitals set high prices to suck as much money from insurance (and patients) as they can. Then the insurance companies set prices to suck as much money from people as they can.

Executives everywhere get rich and the public all gets poorer and gets poor access to healthcare that costs too much.

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DrunksInSpace t1_j0z1pvg wrote

Insurance companies may cover it if it is cheaper than expected long term costs of not having a shot.

I can’t tell you how many teach patients get one suction set up per month to clear their trachs and keep getting hospitalized with recurrent tracheitis and respiratory tract infections (upper and/or lower). Suctioning is a routine procedure that is done aseptically (sterile gloves and equipment) multiple times a day in a clinical setting, with all new equipment each time.

Assuming companies are smart with their money is not always a safe bet.

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absentmindedjwc t1_j12zfkl wrote

The thing OP doesn't understand here - insurance companies may not want to cover it depending on how long term of a cost it is. If there's a chance that they're the ones holding the bag at the end, then they'll happily cover it.... but if the complications of it won't rear its head until 20 years later... they'll gamble that someone else will be left holding the bag when it comes time to pay up.

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TummyDrums t1_j0zfxnk wrote

The trouble is, if your doctor says you need the shot every 3 months, the insurance company will only cover it once every 6 months, and when you get an exception written up by your doctor they'll still deny the request. When a generic comes out that isn't as effective, they'll force you to switch, again against your doctor's orders.

People focus on how expensive healthcare in this country is because of this broken system, but to me the crazier thing is how much your insurance company can dictate how your doctor treats you.

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General_Elephant t1_j0z9frx wrote

Metformin is a really low cost drug right now, so the insurance companies will have "step therapy" meaning you need to fail with the "frontline therapy" to qualify for possible coverage of more expensive alternates.

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Iceree t1_j0zuzpc wrote

This is true. Took metformin, couldn't tolerate some bad side effects, now have a much more effective drug to take AND I get to take it much less frequently then metformin.

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