I work in the healthcare field. I don’t earn a hell of a lot, but I feel I am probably compensated appropriately for the sort of work I do. I also collect Social Security each month, significantly more than the average American does. Consequently I have Medicare Parts A and B, which costs something (not a hell of a lot, but it has a price), and Medicare Part D, which is an arcane “service” tied into Medicare, but run by a bunch of private insurers who toss us a confounding array of plans every six months, from which we may choose what seems most likely to cover the costs of our prescription medications; you know, drugs your doctor prescribes because in the doctor’s judgement these drugs will improve your health and your odds of surviving what ails you.
Medicare, which in recent years has been touted as a panacea for universal healthcare, covers 80 per cent of your medical bills (with certain exceptions) and it allows you to self-refer and see any doctor you please. Great. Not as great as Medicaid, however. Medicare is available only to those of us who have reached the age of 65. Medicaid, on the other hand, is available to those in serious need of assistance, and travels in the company of “food stamps” and SSI (Supplementary Security Income). Age is not a factor and, in fact, one may, given the right combination of age and income, qualify for both Medicare and Medicaid. The latter is the golden ticket however, assuming one qualifies (the program is administered in various forms under various sets of rules which may be very different from state to state, since each state determines how Medicaid will be distributed…if at all.
Since there are so many versions of Medicaid (at least 51 versions) I’ll use Maryland, where I reside, as an example. In the “Free State” one first of all must not have income not to exceed 138% of the poverty level. There’s no point in going into what “poverty level” means. It’s never enough around here anyway. But if one does qualify, almost all medical bills and prescriptions are covered 100%. This is what Bernie Sanders mistakenly has referred to as his ideal “Medicare for All” program. Well call it anything you like, just make it happen. Fast.
“What you’re about to see is the reason for the cynicism that the American people have about the way we do business here in Washington. PhRMA (Pharmaceutical Research and Manufacturers of America), one of the most powerful lobbies in Washington, will exert its influence again at the expense of low-income Americans who will again have to choose between medication and eating.” — The late Sen. John McCain, just before the vote, five years ago, on, a bipartisan bill that would have allowed Americans to order U.S.-made prescription medicines from Canada.
Actual Medicare, though, is a pretty decent program even if one hasn’t formally retired. Well, except for that “Part D” part. That’s a killer for some of us, because although the various plans do cover a goodly portion of some drugs, the structure of the plans, each run by private insurers, is arcane, confusing, and, ultimately, woefully inadequate, largely because the more valuable a medication, the higher its cost (for instance, most generic drugs are “tier 1” drugs, and have trivial if any copay at all. Many of these are “antique” drugs that have been around for decades, have had their patents expire, and often have been superseded by fare more effective drugs (which still have brand names like oh, let’s say “Trulicity” for example. Actually that’s an actual drug name, and the naming of new medicines must itself be a booming industry, as the names become more and more insane (Kesimpta, Farxiga, you name it, they’ve named it something crazy). Most highly effective newer drugs are Tier 3 (ie: very expensive) drugs. Some are Tier 4 (even the copay will bankrupt you, even though the drug might be life-saving).
Recently I have moved from the ranks of socially conscious activists to those of the outraged “senior” group who apparently have managed to live our lives without benefit of having read The Art of War and have yet to earn our first million. In other words, even if we have not retired (and usually it’s because we can’t afford to) we don’t earn enough to quite make ends meet, or perhaps with an average Social Security benefit each month we just manage to make ends meet. Whatever our failings, though, the biggest one is being the wrong person in the wrong body and learning that Medicare Part D doesn’t cover enough of some potentially life-saving drugs (in my case Trulicity, a once-per-week injection to prevent diabetes type II from taking my body apart over time. Type II diabetes is currently turning into a massive epidemic, even though it is not caused by any virus (at least so far as we know), is not contagious, and, just for the record, is not caused by eating sweets. It isn’t even caused by being overweight, though if one is overweight one is far more likely to develop this scourge and consequently will have a harder time controlling this disease which can destroy one’s kidneys, urinary tract, heart, and lower extremities, to name only most of the potentially disastrous ways diabetes can take down an otherwise healthy person.
“My” diabetes (my parents both had it, as well as numerous aunts, uncles and cousins) is currently out of control. I was diagnosed with it thirteen years ago and for the first few years I was able to manage it with moderate exercise, diet and weight control. Then it started to do the creep the way it did to my mother, who finally died miserably at age 85, blind (diabetes), unable to walk (diabetic neuropathy in her feet which not only hurts but can also cause the lower — and sometimes even the upper — extremities to go numb (yet tingle and burn like Hell). The medications my mom had recourse to were often effective but not always, and not for her. She died 25 years ago after a long wasting, and there was no Trulicity for her. I’m not sure she’d have used it anyway, since so many of my relatives shuddered at the thought of injecting themselves with anything. Still, were she around now, it would be another option, one of what seem to be hundreds, at least if we watch Jeopardy! and pay attention to the drug commercials that saturate the dead air breaks when we are hounded by those Mad Men’s creations. It seems the majority of them are hawking fabulous new anti-diabetic medications.
Big Pharma, in 2020, spent $646 billion on advertising, two-thirds of it on TV ads.
I always get excited when I see/hear a new drug name show up in the cluster of commercials, then amused — by the new and ridiculous names, and finally enraged when I realize I cannot afford any of them, including Trulicity, which, after Medicare Part D is through with it, would still cost me well over $600 for an 84 day supply (the closest they can come to a 90 day supply, because it’s preloaded injector pens, not pills like Januvia, another Tier 3 drug for which I two years ago paid anywhere between $70 per month and $550. With the Part D insurance I have, all Tier 3 drugs (meaning all the good ones) cost the same, although Januvia (love the name yet?) has never done anything for me. Nada. Zilch. Before I took that plunge I had been using metformin, one of the oldest and most effective drugs, but one which also has some terrible side effects, including nausea, bloating and diarrhea. Oh, and I mean diarrhea that’s magical. Diarrhea that can barely be controlled while one is awake, and which, should one dare to sleep, deliver the unpleasant surprise of waking in a bed full of one’s own fecal waste. Yes, this happened to me at least twice, and I can think of few things as demoralizing. Of course one also cannot work, at least not my line of work, while having to run to the bathroom suddenly before one craps one’s pants. (I recently revisited metformin in hopes the same thing wouldn’t happen. Within 24 hours of having taken the first one, I had to streak to the bathroom to avoid more trauma. The next thing down the toilet was the 90 day supply of metformin. Well actually, no, I don’t dispose of medications that way. Still, it is gone. So is the cramping and uncontrollable diarrhea.
I also take another generic drug for diabetes, an “antique” one called glipizide. For a while I took glipizide with Januvia, and that combo worked. It worked for about a year, and then the glipizide turned on me and caused my blood glucose levels to plunge (twice) to 35 ml/dl. That’s dangerously low, and the first time required me dialing 9–1–1 and having the local ambulance crew make me PB & J sandwiches until my sugar was alarmingly high. All I had to do was back off on the glipizide dosing, though, to avoid that foolishness.
Then the combo started to not work well. Then not at all. The Tier 3 Januvia ceased to do anything for me. It continues to do nothing, but I have about a month’s worth left, and it has no bad side effects, so I figure I may as well use it.
I’ve exhausted the formulary of my insurance and there are only a few tier 1 drugs left. I’ve used them all. Yes, I even used Actos (generic name: pioglitazone), even though I knew it had once been recalled because it can cause bladder cancer. It didn’t do that to me. But it can also cause weight gain (due to water retention) and aggravate congestive heart failure, both of which can cause pitting edema (swelling) of the legs, ankles and feet. I gained something like 18 pounds, increased my shoe size, and permanently damaged some of my leg veins, which had to be closed surgically to improve blood return and reduce (though not eliminate) the lower extremity swelling, which goes really well with the excruciating burning and numbness in my feet.
All of this brings us back to Trulicity (or any other highly effective Tier 3 drug). I was willing to east the cost of the first round because I assumed I’d tear through the plan’s deductible really fast with that stuff. I was right, but what I didn’t see coming was the dreaded “donut hole” or “gap,” as Medicare likes to call it. At that point I was expected to pay $600-some dollars every 84 days for the right to inject myself once a week and enjoy excellent glucose control and even lose a little weight. But I cannot afford it. It’s either Trulicity or food and…yeah, yeah, I know, if I would just not eat all the food I buy (or maybe give it up altogether) I might — just might — bring my now frightening blood glucose numbers down before my kidneys are damaged or my heart (which was pretty well damaged in 1994 way before I was diabetic) or maybe I’ll lost a toe or two or a foot or a leg or become impotent (oh HELL no!) or lose my eyesight as my mother did (and I am having a Hell of a time seeing right now, trying to type this, but my glasses are no longer effective enough to bother to hunt them down), and need I say it again, I need to eat food, which costs me just about the same per month as Trulicity does every 84 days. So even if I were to somehow manage to stretch my monthly food budget out over almost 3 months, I still wouldn’t be able to afford Trulicity or one of its equally fancy, highly effective, absurdly expensive antidiabetic drugs.
Welcome to life on the first tier, the low-hanging fruit of the drug business, while anyone with non government-funded health insurance (you know, big corporate insurance) can use one of the discount cards offered by Eli Lilly, and buy a box of the pens for $9. That’s $9 per month, $27 per three months instead of $663 for the same number of injection pens.
My endocrinologist, when asked by me how I might solve this problem, said “I can offer you a four week supply of Trulicity samples, if that helps.”
Yeah, it does help. For 28 days. Then the death crawl begins again.
My endocrinolgist has excellent insurance and pulls down a sweet income. I just hope she doesn’t get sick and become one of us.
Needless to say the same thing is true for the best heart drugs, the best cancer drugs, the drugs most likely to keep us alive and functioning. Of course, by the time you’re my age you’ve become a drag on the industry and should be neutralized anyway, or so I’ve heard. From drug reps. In the hospital where I work.
I don’t look my age.
Those of you who haven’t reached age 65 yet, or who have already made your first million, there’s this: Big Pharma is waiting for you, waiting to sing Happy Birthday and push you into a handy canal.
Work hard now. Don’t enjoy your life. Get the best insurance capitalism can buy you, earn as much as you can, do everything right — and for the love of God, don’t get sick or hurt and lose your job or become disabled. Stay golden.