POZ Community Forums
Meds, Mind, Body & Benefits => Questions About Treatment & Side Effects => Topic started by: chgo2012 on October 17, 2012, 02:25:46 pm
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I'm a Kaiser permanente member taking 2 drugs regimen, Sustiva and Epzcom. Recently Kaiser sent me a letter saying that Epzcom "became" generic and that instead of ONE (Epzcom) pill per day I will have to take 3 of the replacement and all of that, without any SAVINGS for ME. I been talking to some people that are very skeptical about generic medicine especially the ones that treat life threatening diseases as HIV. I need opinions and also to know if Kaiser and their doctors could be held responsible for treatment failure (if occurs) for such change that for the insure make absolute no difference. I pay over 10K for HMO plus all sort of co-pays, amazes me to know that Kaiser still want to "play cheap" with people's lives in order to save money for THEM. I appreciate guidance and feedback. Are you insured,(individual? What company, how much you pay? Do you take Epzcom? Have had that replaced by generic as well? thank you)
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I'm with Kaiser also. I am not on Epzicom though. It seems strange the generic one would have a different dosage than the prescription.
On all Kaiser plans I have ever been on, the copay for generics is lower than for brand name drugs, I would be surprised if this not the case for your plan also.
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I already checked with Kaiser, doctor and pharmacist and Epzcom will be replaced by 3 other pills and MY final cost will be EXACTLY what I been paying for the brand. (1 bottle will be replaced by 3). It's not about the dosage, but the discomfort of taking 3 pills (plus what I already take) and without money savings for me. I was told and read that generics are NEVER just like brand. Shame on Kaiser. I wonder if other insurances are saving on member's lives.
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I was told and read that generics are NEVER just like brand.
really? where did you read this?
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I've taken this same regimen since Epzicom first came out and have never heard anything about it becoming generic, especially since the patent (http://www.drugs.com/availability/generic-epzicom.html) isn't set to expire before 2018.
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I've taken this same regimen since Epzicom first came out and have never heard anything about it becoming generic, especially since the patent (http://www.drugs.com/availability/generic-epzicom.html) isn't set to expire before 2018.
The patents on the two individual drugs that make up Epzicom have expired. It's only the patent on the combo pill that has yet to expire.
The two drugs that make up Epzicom are Ziagen (aka abacavir) and Epivir (aka lamivudine, 3TC).
Abacavir is dosed at two 300mg tablets once a day.
Lamivudine is dosed at one 300mg tablet once a day.
This is why the OP is having to replace one pill with three.
There are plenty of people who take generic hiv meds and they're doing just fine. I don't know where the OP is getting his "information" regarding generics, but it's wrong.
Chgo, are you sure the switch to generics won't lower your copay? I seem to recall at least one other forum member recently mentioning going generic and being happy about it because it substantially decreased his copay.
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A. generics have the same active ingredients as the brand, so you should be fine
B. I find it hard to fathom that your co-pay won't go down with a generic -- unless they are forcing you to play 2 generic co-pays which equals 1 brand name copay
C. Even if your co-pay DOES stay the same -- the cost to Kaiser certainly will go down. As they are, I assume, paying the bulk of the cost they have a right to say you must take the generic OR you can stay with the brand name drug and pay for it yourself (or, perhaps, only pay the difference between the brand & generic costs).
So -- they aren't forcing you to do anything -- you have the right to stay with whatever drug brand you want -- they are simply saying that they will not pay the cost of a Brand if a generic is available.
Mike
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Thank you for all the info.
As far as the information regarding generic being equals brand, I have professionals/friends with high graduation and knowledge about chemistry and pharmacy and they do are skeptical about it.
I sent a message to my doctor, called the pharmacy center and the answer is the same, because of the number of pills, 3, the copay will still the same (they wish could be more) ... I pay $ 30 for brand, $ 15 for generics so, 2 bottles of 300 mg Abacavir plus 1 bottle of Lamivudine will be equals $ 30.00 co pay (they wish could be $ 45.00).
I wonder if other companies are going generics also in order to save for themselves only in exchange of the discomfort of offering 4 pills instead of just one brand.
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Before I re order my meds I will talk to Kaiser about charging me only ONE co-pay of $ 15.00 instead of 2 as they want, since I will be taking more pills for their convenience.
There's something called "rule of bio availability" regarding generics x brand.
A brand must contain 100% of the active ingredients completely regulated.
A generic do not need to meet standards = the active ingredients can be equals 80% or 120% which in treatments of sensitive diseases as HIV, can be inefficient for the treatment in one month and overdose on the next.
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I would be annoyed also if my insurance company told me I would have to take 3 pills instead of my one Atripla.
That said, generics are just as effective as brand names. Here is info from the FDA
Health care professionals and consumers can be assured that FDA approved generic drug products have met the same rigid standards as the innovator drug. All generic drugs approved by FDA have the same high quality, strength, purity and stability as brand-name drugs. And, the generic manufacturing, packaging, and testing sites must pass the same quality standards as those of brand name drugs.
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingGenericDrugs/default.htm
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I was told and read that generics are NEVER just like brand. Shame on Kaiser. I wonder if other insurances are saving on member's lives.
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Do you have any studies to prove that generic meds aren't as effective as brand meds, or are you just propagating hearsay and urban legend?
As far as the information regarding generic being equals brand, I have professionals/friends with high graduation and knowledge about chemistry and pharmacy and they do are skeptical about it.
If your friends are truly scientists and researchers, they would be willing to show you some evidence.
This is largely an issue of perception, because for most consumer goods the term "generic" implies something with less value than a brand name item. But we're not talking about breakfast cereal or salad dressing here. The FDA reviews and approves applications for generic drug manufacturers, and monitors their production the same as it does for brand name drugs manufacturers.
http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htm (http://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/understandinggenericdrugs/ucm167991.htm)
Generally, this fear of generics infuriates me, as it increases healthcare costs for everyone. Unless generics are forcing you to actually change the drugs in your regimen, I think you should quit whining and take them. If generics do mean actually changing drugs (and I mean the actual drug, not just brand versus generic), well that's a bigger gamble for those of us with HIV -- especially those who have worked hard to find a combination that works for them.
I suppose it is also irritating that the savings are not passed on to you. But your co-pays are, honestly, very low compared to many. And the difference in your brand and generic co-pays don't reflect the actual cost difference between the two. That is something that is changing more and more in the insurance industry. For example, my co-pay for brand is $178 (yes, almost $200), but my co-pay for generic is $24.
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I would be annoyed also if my insurance company told me I would have to take 3 pills instead of my one Atripla.
But, you see, they aren't saying you HAVE to take 3 instead of 1 -- they are saying that, if you want them to pay the bulk of the cost, you have to take 3.
I find it hard to understand when people complain about the high cost of health care on the one hand, but if it isn't hitting their pocket, they don't care that "someone else" is paying more than medically necessary.
It would be great if some of the savings was passed on though.
Mike
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The patents on the two individual drugs that make up Epzicom have expired. It's only the patent on the combo pill that has yet to expire.
The two drugs that make up Epzicom are Ziagen (aka abacavir) and Epivir (aka lamivudine, 3TC).
Abacavir is dosed at two 300mg tablets once a day.
Lamivudine is dosed at one 300mg tablet once a day.
This is why the OP is having to replace one pill with three.
Thanks, Ann, that explains it.
Chgo, are you sure the switch to generics won't lower your copay? I seem to recall at least one other forum member recently mentioning going generic and being happy about it because it substantially decreased his copay.
Kaiser plans usually have one copay for generic drugs, and another copay for brand name drugs.
Going from one paying one copay for brand name drug (Epzicom) to two copays for generic drugs would result in savings with most plans, but perhaps not all, it depends on the plan design.
With my current employer plan, the copay is $5 for generics and $10 for brand name for up to 100 day supply, so it would be a wash.
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Abacavir is dosed at two 300mg tablets once a day.
Lamivudine is dosed at one 300mg tablet once a day.
This is why the OP is having to replace one pill with three.
Thanks for the reminder of how convenient Epzicom is. Been there/done that as I was on that regimen when Ziagen first came out ;)
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bocker3,
But, you see, they aren't saying you HAVE to take 3 instead of 1 -- they are saying that, if you want them to pay the bulk of the cost, you have to take 3.
Actually, Kaiser is an HMO and they have a formulary for drugs they will cover and will not. This formulary can and does change over time.
Many years ago I was on a brand name proton pump inhibitor called protonix - pantoprazole. Kaiser notified me that they were no longer covering this drug. I had to start taking a totally different drug, omeprazole, generic for Prilosec. It did save me money because I went from a brand name copay to a generic copay, and the replacement drug worked fine also, so I did not complain.
I find it hard to understand when people complain about the high cost of health care on the one hand, but if it isn't hitting their pocket, they don't care that "someone else" is paying more than medically necessary.
It would be great if some of the savings was passed on though.
I believe the Affordable health care act does force the insurance companies to pass on cost savings - if they don't spend at least 80% of their premiums on care, they have to offer premium refunds.
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bocker3,
Actually, Kaiser is an HMO and they have a formulary for drugs they will cover and will not. This formulary can and does change over time.
Many years ago I was on a brand name proton pump inhibitor called protonix - pantoprazole. Kaiser notified me that they were no longer covering this drug. I had to start taking a totally different drug, omeprazole, generic for Prilosec. It did save me money because I went from a brand name copay to a generic copay, and the replacement drug worked fine also, so I did not complain.
Not sure of your point here -- I was merely pointing out that Kaiser wasn't "making" anyone change anything -- they were simply saying "we will pay for this and not that". One would be free to take any drug that is off formulary -- you would just have to pay for all of it.
I worked for an HMO in Boston back in the 90's (their heydays), so I understand how they operate and how they attempt to keep costs down.
I believe the Affordable health care act does force the insurance companies to pass on cost savings - if they don't spend at least 80% of their premiums on care, they have to offer premium refunds.
I believe that is true also -- although, I think it is in the aggregate, not for individuals (many young, healthy folks don't get anywhere near 80% of their premiums spent on health care for them). So, not sure this cost savings will have to be passed on (whether it should be shared is another matter) as I doubt it is a material savings when looking at all the medical costs Kaiser pays out.
Mike
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" ... With my current employer plan, the copay is $5 for generics and $10 for brand name for up to 100 day supply, so it would be a wash. "
That's why people keep voting for the wrong people, because they are completely clueless about the cost of things if they lose their jobs as more and more people are losing everyday.
I'm a self employed and even when I had jobs that paid for health insurance, I never trusted them because was always some sort of lousy policy.... so, I have my individual policy for over 20 years (different companies) so.. I saw all the raises, cuts and differences...
Kaiser keep bragging about the excellence of their services but for what I been paying, they couldn't be any worse.... for people that doesn't know about costs of health care.. I pay $ 720.00/month plus $ 200 deductible/year for meds, $ 30 rx brand/$ 20 generic. Doctor visits primary $ 30.00 and specialist (in house) $ 50.00.... if the specialist request exams, as soon as they get the result if I have to go back in (within few days) they will charge me another co pay....
Because people accept everything is that we got on this situation that no many people can afford health care anymore.... $ 10,000 is a very high cost for such lousy treatment .. and has been that high (and going up every year) even when I had no health issues.
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Hi,
Back to the OP, one of the problems I see, is that in combining ABC+3TC in a complex blending and choice of additives, the formulation has a longer bioavailability.
The manufacturer of the coformulated took great care in formulating, prpocessing and clinical evaluation so that ABC which originally was twice daily, became oncedaily when manufactured in the co formulated form.
In the non-coformulated form ABC + 3TC is not once daily (original older formulation as well as generics). It is (if my recollection of reading the labels is correct) twice daily
And all those on this forum who acclaim once daily regimen may understand the frustration of users of once daily regimen being forced back to twice daily dosing.
generic ABC is bioequivalent to original ABC, generic 3TC is bioequivalent to original 3TC, BUT generic ABC+3TC is NOT equivalent to coormulated (ABC+3TC) aka epzicom aka Kivexa
I am under the very same 'threat' and will discuss it with my doc.
He 'sold' me on viramune+Kivexa (vs Atripla) on hte basis that is also once daily. But if it becomes once daily no-more, hten I feel 'cheated'
Hope this helps clarify the OP's concerns (or, at the very least, mines)
Eric
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Thanks Eric for you input,
Amazes me to see people trusting doctors and even and "especially" FDA with their LIVES.
And I'm not WHINING, I'm just take care of myself.
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Not sure of your point here -- I was merely pointing out that Kaiser wasn't "making" anyone change anything -- they were simply saying "we will pay for this and not that". One would be free to take any drug that is off formulary -- you would just have to pay for all of it.
I worked for an HMO in Boston back in the 90's (their heydays), so I understand how they operate and how they attempt to keep costs down.
I don't know how this would work if the doctor prescribes the drug that is off formulary, I am not sure if the Kaiser pharmacy would stock it and dispense it, but I admit I have not been in that situation.
I believe that is true also -- although, I think it is in the aggregate, not for individuals (many young, healthy folks don't get anywhere near 80% of their premiums spent on health care for them). So, not sure this cost savings will have to be passed on (whether it should be shared is another matter) as I doubt it is a material savings when looking at all the medical costs Kaiser pays out.
I believe the premium refunds only apply to group plans, not to individual plans. Kaiser did not send me any refund this year, but I have heard of people getting some refund checks from their employers on other plans.
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" ... With my current employer plan, the copay is $5 for generics and $10 for brand name for up to 100 day supply, so it would be a wash. "
That's why people keep voting for the wrong people, because they are completely clueless about the cost of things if they lose their jobs as more and more people are losing everyday.
I'm a self employed and even when I had jobs that paid for health insurance, I never trusted them because was always some sort of lousy policy.... so, I have my individual policy for over 20 years (different companies) so.. I saw all the raises, cuts and differences...
I am very well aware of the costs, I have lost my job before. I know how much COBRA costs.
And my paycheck lists the full cost of my premiums, not just the employee share. The employer adds some "flex dollars" to the pay stub to pay for the benefits.
Even with my employer plan, I also pay income taxes on the employer coverage for my domestic partner. The employer is supposed to cover about 80% of the premium, and my share is about 20%. However, taxes are due on 100% of his coverage cost, so in reality I pay about 60% of the cost of his coverage with the taxes included.
Kaiser keep bragging about the excellence of their services but for what I been paying, they couldn't be any worse.... for people that doesn't know about costs of health care.. I pay $ 720.00/month plus $ 200 deductible/year for meds, $ 30 rx brand/$ 20 generic. Doctor visits primary $ 30.00 and specialist (in house) $ 50.00.... if the specialist request exams, as soon as they get the result if I have to go back in (within few days) they will charge me another co pay....
Because people accept everything is that we got on this situation that no many people can afford health care anymore.... $ 10,000 is a very high cost for such lousy treatment .. and has been that high (and going up every year) even when I had no health issues.
I think the problem is mainly that you are in small plan, and that's why the premium and copays are so high. As a small business you have no leverage with Kaiser. We need the ACA to take effect ASAP so everybody can be in large group plans, in the exchanges.
One of the main reasons I work for a large company and have not considered starting my own business is for the health benefits. My doctor visits are $10 currently. I have never had to pay a single dollar for any test with Kaiser on my group plan.
Looking at my pay stub, my Kaiser coverage only costs $150/paystub which is 24 times a year. That is $3600/year. One third of yours. The cost for my partner is another $154/paystub, about the same, but is taken after-tax. And yes, this is the total cost, not the employee share. But this is with a company with over 100,000 employees so the group must be quite large, though there are many different plan options. Kaiser is by far the cheapest option.
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" I believe the premium refunds only apply to group plans, not to individual plans. Kaiser did not send me any refund this year, but I have heard of people getting some refund checks from their employers on other plans."
Interesting isn't it? Companies pay less, get taxes breaks and in the end refunds.... individuals have to pay a LOT of money and no refunds of any kind... just raises.... if Mr Romney wins, I wonder how "unemployed" people will pay for their care.
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Interesting isn't it? Companies pay less, get taxes breaks and in the end refunds....
The companies are supposed to pass the premium refunds down to their employees in some way, and many have.
http://www.nytimes.com/2012/08/10/nyregion/health-insurance-refunds-may-stall-in-employers-hands.html?pagewanted=all&_r=0
individuals have to pay a LOT of money and no refunds of any kind... just raises....
Premiums for employer-sponsored coverage have also been rising rapidly, it's just less visible to the employee since the employer typically picks up the majority of the tab.
if Mr Romney wins, I wonder how "unemployed" people will pay for their care.
Why, they will go to the ER, as he said so himself.
To be fair, I think the whole concept of individual health insurance is flawed.
The main problems are that insurance companies are allowed to deny anyone if they so much as sneeze, and individuals who don't have employer-sponsored coverage are not able or allowed to join groups which would let them get reasonable rates, as well as leverage. I think the Affordable healthcare act at least attempts to solve both of these. We can only hope that it will take effect in 2014 as planned, even if Romney is somehow elected.
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"Why, they will go to the ER, as he said so himself.
To be fair, I think the whole concept of individual health insurance is flawed.
The main problems are that insurance companies are allowed to deny anyone if they so much as sneeze, and individuals who don't have employer-sponsored coverage are not able or allowed to join groups which would let them get reasonable rates, as well as leverage. I think the Affordable healthcare act at least attempts to solve both of these. We can only hope that it will take effect in 2014 as planned, even if Romney is somehow elected."
Sounds all wrong to me... all the sacrifice that I make to be safer isn't paying off... they keep pushing and squeezing me to the point that I might have to give up and do as many people do, going to ER, getting huge bills, have to deal with bill collectors, declaring bankruptcy or simply don't paying anything to anyone and have to deal with the worst treatment possible... Must have a better way, if not a way around, Kaiser already told me that my $ 720.00 month premium will going up again in January of 2013... I just can't understand the difference, and the reason why they created some sort of change that would take until 2014 to be effective when we have to live TODAY. Am I by myself on this... ? That make me understand why so many wealthy people deny paying taxes and get their meds from the government for free....
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I just can't understand the difference, and the reason why they created some sort of change that would take until 2014 to be effective when we have to live TODAY. Am I by myself on this... ?
No, I think it's a real shame that this aspect of health care reform, arguably the most important one, got delayed as long as it did.
That make me understand why so many wealthy people deny paying taxes and get their meds from the government for free....
Now you have lost me.
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I've been taking generic epivir and ziagen for nine years. It seems to be working for me. Still here, still kickin, working a full time job where I missed only two sick days in the past ten years.
I take epivir and ziagen both twice a day (using the 150mg epivir) and prefer it to once daily. Why? Because I virtually NEVER miss two doses in a day. It is very rare that I ever miss any dose, but when I do, it's just 1/2 a dose that got missed, not the entire day's. If I missed a once daily dose, I may not realize it until the next time I have to take it, meaning I've missed an entire day's meds. Of course this logic only works if you have a really good routine so that you're near 100% adherence.
I dare to say there are most likely more generic HIV drugs consumed in the world than brand name ones. You'll be fine on the generics and be doing your part to lower health care costs.
Might I add your chemist friends must be completely uninformed to make such a statement that generics won't work. If that were the case, HIV death rates would not have been drastically reduced in the third world after generic HIV meds were made available.
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Might I add your chemist friends must be completely uninformed to make such a statement that generics won't work. If that were the case, HIV death rates would not have been drastically reduced in the third world after generic HIV meds were made available.
This is an interesting note... death rates have drastically reduced everywhere despite different guidelines and treatment strategies.
I have never come across cohort data that demonstrate an equivalent success rate for the generic form (in other words in 'poor' countries) vs the original one. Most likely because there would be many confounders (backbone and initiation strategies being different)
I am under the impression that life expectancy coming back to normal (for a subset of people) has been reported from European cohorts, but not from US cohorts and to my knowledge not from ressource limited countries. (I think there is now an extended VA cohort that aggregates the va-cohort and some hospital cohorts in South Africa, but I am not 100% sure)
In other words, there is a mixed bag of public health policies and strategies, but, it is stretch to assume that all strategies lead so same results (in a quantitative and quantifiable fashion)
As 'generics' and 'branded' will now compete for market share in rich nations, we can expect that the original brand will try to provide data (if there is any...)
That being said, the pharmacokinetics are OK if you take it twice daily
It had been reported that off-label once daily dosing (2 pills once daily instea of 2 times one pill) can be same in some cases (Viramune, if the patient is treatment experienced and, I might add, if the patient is not overweight).
I had underestimated the comfort of once daily until I switched to once daily. People have different lifestyle and habits... Now that I am once daily, I feel much better (less stress). There is noway I am moving back
I will ask my doctor what he thinks about the generics since he has extended experience in providing medical advise to his African colleagues and goes to conferences and stuff over there
Cheers
Eric
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your part to lower health care costs.
This is a legitimate concern for those people who contribute financially to the health system for less (often much less) that they benefit from.
On the other hand this is the least of concern (and even a potentially offending proposal) for people whose financial contribution to the system far exceeds what they get back from it.
In other words socialized or mutualized health care is OK as long as it is good quality. It sucks if you see (as I am seeing here) premiums increase for the higher income person and Quality of Service decrease (and in a communist country like mine, the same (not-as-good-as-it used- to be) service applies to all)
Just a rant, no offense
Eric
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That make me understand why so many wealthy people deny paying taxes and get their meds from the government for free....
Now you have lost me....
when we get at the point that not even having a health insurance means quality of services, attention, assistance without having the prices constantly going up, if we need, cutting of benefits, new co pays etc, even and especially wealthy people just drop it, and go as everyone else to suck from the government for free... I KNOW many people that could "easily" pay for their treatment or at least have a health insurance... but why they would? If corrupting the system became so easy?
I start to feel stupid for make so much sacrifices to pay my individual policy when the insurance companies do everything possible to get rid of me.... charging me twice, 3 times what they charge to companies and with full government support...
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Eric48, thank you again for your wise input, based on your words I can tell that you have knowledge on this field.
Because "some numbers" shows improvements that doesn't mean that many people are being victim of treatment failure. After 30 years of fight and millions spent we "just deserve" the best available possible.
As in some countries even not as rich as the USA, medications for life threatening diseases such hiv, cancer, etc should be COMPLETELY ACCESSIBLE AND FREE
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Because "some numbers" shows improvements that doesn't mean that many people are NOT being victim of treatment failure.
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.... I can tell that you have knowledge on this field.
Nope... I am just voicing one patient's (me) perspective. A knowledgeable or wise person opinion should encompass all individual possible situations and guide decision towards an optimum that is acceptable to all
That the job of a politician, which I am not
I just want to say that, as far as I know, I have never come across a 'golden standard' double blinded clinical study that demonstrates that generics are as good as the banded ones.
The concept of generics is generous and has been as tremendous public health improvement.
It has allowed people whose life is (was) valued less than a few thousands dollars to afford those caviar drugs ersatz and save their lives. I strongly support the concept
Allowing 'poor' people to travel second class with a third class ticket (and save their lives/economy/country) is simply so humane that is almost non-human. It is a wonderful achievement
BUT, asking people to pay first class and travel second class is just a rip off.
Which is why I sympathize with the OP
Cheers
Eric
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thank you.
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if people wasn't so passive, things like that won't happens so often any more. Drugs for diseases as such would be available to all and completely free of charge. If countries with less resources can do it, USA should be ashamed for being so different. Same thing with this health insurance discrepancies between individuals and companies... insurance companies should be investigated right away. With people being more proactive, everybody would win (even the ones that doesn't need help YET) and we didn't have to read people mocking other in need as the one that said that I'm whining.
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The whinning comment was made early in this thread and you have now whined about it twice. :o
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and your point is? Anything to add, to help?
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I called Kaiser today and they told me that, since I will have to take more pills, I will have to pay "more" which will be the cost of the brand and because of such change the doctor ordered just "one month supply" (not 3 for 2) which will be even more expensive to me.
On top of everything in Atlanta there's NO specialist doctors IN TOWN, they are ALL 20 miles (plus) away from the city in a city where lacks public transportation on most areas.
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I decided to call "one last time" and to talk to my doctor... sent them an email, asking (again) the reason why I should take generics, even more pills for the price or brand, also I asked why they keep my meds hostage for only one month... after a couple of minutes I got the answer that KAISER WILL KEEP ME ON THE BRAND and ordered the months supply needed/request.
I do recommend anyone to at least "try".... even when things are very hard and some people will tell you to give up... you are not a statistic but a human being that deserve respect and what's right.
Thank you for the patience, attention and support.
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when we get at the point that not even having a health insurance means quality of services, attention, assistance without having the prices constantly going up, if we need, cutting of benefits, new co pays etc, even and especially wealthy people just drop it, and go as everyone else to suck from the government for free... I KNOW many people that could "easily" pay for their treatment or at least have a health insurance... but why they would? If corrupting the system became so easy?
I'm still not following you at all. Medical costs can be very high and a long hospital can bankrupt even wealthy people. They are not stupid, they have assets to protect that they don't want to lose in a medical bankruptcy, they will at minimum carry some catastrophic insurance, provided they are able to qualify for it, which they usually can through a work group plan. They actually have the most to lose if they are uninsured. People who are insolvent have less to lose from being uninsured - the hospitals will never collect a dime from most of them when they go to the ER. The wealthy are not the ones going there !
None of this has much to do with taxes. In general the government in this country does not not take care of you very well if you do end up destitute, and the wealthy know better than anybody not to rely on government, after all, they will do everything in their power to avoid paying for anybody else's cost through their taxes.
I start to feel stupid for make so much sacrifices to pay my individual policy when the insurance companies do everything possible to get rid of me.... charging me twice, 3 times what they charge to companies and with full government support...
We have a broken system. People with individual policies, or worse, no insurance policies at all, are absolutely getting the shaft. They get charged much higher premiums than others, or get charged inflated prices. And they get worse care. But none of this has much to do with paying taxes, it has to do with the lack of current regulation. The affordable care act at least should fix many of the inequities in the premiums, and the biggest of problem that many people are unable to access insurance at all.
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Because "some numbers" shows improvements that doesn't mean that many people are being victim of treatment failure. After 30 years of fight and millions spent we "just deserve" the best available possible.
Again, you have not provided any evidence that the generics in this country work any differently than the brand names. Of course some people experience treatment failure, but that happens with both brand name and generics, not more or less with one or the other.
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Hi,
In the non-coformulated form ABC + 3TC is not once daily (original older formulation as well as generics). It is (if my recollection of reading the labels is correct) twice daily
And all those on this forum who acclaim once daily regimen may understand the frustration of users of once daily regimen being forced back to twice daily dosing.
generic ABC is bioequivalent to original ABC, generic 3TC is bioequivalent to original 3TC, BUT generic ABC+3TC is NOT equivalent to coormulated (ABC+3TC) aka epzicom aka Kivexa
I am under the very same 'threat' and will discuss it with my doc.
He 'sold' me on viramune+Kivexa (vs Atripla) on hte basis that is also once daily. But if it becomes once daily no-more, hten I feel 'cheated'
Hope this helps clarify the OP's concerns (or, at the very least, mines)
Eric
I agree the once daily vs twice daily would be a significant difference if it was true. According to what Ann posted earlier, it's not accurate. The two generic drugs are both once daily. You just have to take two pills of one generic, and one pill ofthe other generic. So you can take all 3 generic pills at once, instead of taking one brand name.
I agree that this is a bit less convenient for the patient, you have 3 times as many pills in your pillbox. But the therapeutic effect should be just the same.
If anything, the fault is with the insurance company for not designing a better plan that gives the patients a financial incentive to take generics, to align the patient costs with their own costs. For many Kaiser plans, 2 generic copays = 1 brand name copay, so there is no incentive for patients in this case to take generic.
The company could design a plan where the brand name copay is 3x the generic copay. They can do that either by lowering the generic copay or increasing the brand name copay. Since they are for profit companies, they will probably do the later. But in reality they should probably do the former, perhaps eliminating all generic copays, or making them a very low token amount like $1. After all, you can get many generic drugs at Walmart for $4 already with no insurance, so why should you have to pay any copay for a generic when you are paying a monthly insurance premium ?
I don't think anybody would be insisting on taking brand name drugs if the generic copays were zero.
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chgo2012,
I called Kaiser today and they told me that, since I will have to take more pills, I will have to pay "more" which will be the cost of the brand and because of such change the doctor ordered just "one month supply" (not 3 for 2) which will be even more expensive to me.
Kaiser plans don't charge by the pill. This is simply an error in the way your doctor wrote the new prescription for the generic. An email to your doc would have fixed that. My doc responds to email very quickly on kp.org.
For maintenance meds, always tell your doc to write them for the maximum period your plan will allow to be dispensed at one time. Usually they will only write one month the first time around to make sure the med is OK for you, then you can switch to 90-100 days if your plan covers that. But that wasn't necessary when just switching from brand name to generic.
Get your meds through the mail also, with many Kaiser plans it half the price by mail vs in-person pharmacy, regardless of generic vs brand name. For my current plan, the price is the same, but it is much more convenient to get meds in the mail, as I am now 15 miles away from the Kaiser location I go to, so it saves a lot of time.
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I decided to call "one last time" and to talk to my doctor... sent them an email, asking (again) the reason why I should take generics, even more pills for the price or brand, also I asked why they keep my meds hostage for only one month... after a couple of minutes I got the answer that KAISER WILL KEEP ME ON THE BRAND and ordered the months supply needed/request.
I do recommend anyone to at least "try".... even when things are very hard and some people will tell you to give up... you are not a statistic but a human being that deserve respect and what's right.
Congratulations, but your victory will probably be short lived. Kaiser will likely come to their senses and find a better financial incentive for you to take the generic by raising your brand name copay more than they will raise your generic copay at some point.
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I decided to call "one last time" and to talk to my doctor... sent them an email, asking (again) the reason why I should take generics, even more pills for the price or brand, also I asked why they keep my meds hostage for only one month... after a couple of minutes I got the answer that KAISER WILL KEEP ME ON THE BRAND and ordered the months supply needed/request.
I do recommend anyone to at least "try".... even when things are very hard and some people will tell you to give up... you are not a statistic but a human being that deserve respect and what's right.
Thank you for the patience, attention and support.
You keep complaining about the increases in insurance and now you are part of the problem. You are insisting on taking a higher priced brand drug, when there is NO DIFFERENCE between brand and generics ability to keep your virus at bay.
Yes, it would be great if we had a different health care system -- but we don't. Until it changes, we need to live with what we have.
People like you are part of the reason prices go up -- you want what you want, but you want someone else to pay for it. Spare me your whining about costs until you stop being part of the problem.
Mike
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People like you are part of the reason prices go up -- you want what you want, but you want someone else to pay for it. Spare me your whining about costs until you stop being part of the problem.
unbelievable....
I pay over 10k per year and suppose to settle for whatever the system wants just to save them some money and with "PEOPLE LIKE YOU" support....
that's the reason why the USA is behind in many things, too many sheep afraid to defend their real rights and afraid of the big ones. There's nobody paying anything for me at all.. otherwise, there's plenty of wealthy people getting treatment and pills for free around. I feel sorry for people afraid to fight getting upset for the ones that obtain what they deserve for doing so. Good lucky to you guys
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Who are these mythical "wealthy people getting treatment and pills for free" you keep mentioning? People don't suddenly start getting free medical care just because they're rich. If you're saying they don't have copays, then they're probably paying even more than you for their insurance.
There's no such thing as "treatment and pills for free" anywhere in the world, not even in the UK where we don't pay directly for our hiv care. We pay for it through our taxes which, by the way, are higher than those in the US. I gladly pay more in exchange for not worrying about my health care. We cut out the expensive insurance middle-man.
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As generics gets approved for sales in 'rich' countries (where they where not legally available), then there is all reasons to believe that sales volumes of branded ones will plumet.
Either BigPharma will let that happen and abandon that territory to those generics manufacturers (which belong to big pharma any way) or they will match the price
If there is no price heaven anylonger, I so not see how branded meds remain on the market at that price level much long.
Reducing the profitability of Big Pharma will also reduce their incentives to develop new meds. Already Boehringer (manufacturer of Viramune) has announced that they are closing their anti viral teams.
This is too bad because this will affect the future of newer drugs within a given class but also that of newer, innovative new classes
It is the money that we spend on meds that fuels research.
There is no public funding to take over
And what may be seen as an economic gain by some, may end up being a huge loss of new therapaeutic opportunities
At the end I do not know whether we, as patients, will benefit from this
Eric
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Reducing the profitability of Big Pharma will also reduce their incentives to develop new meds.
Indeed. Incentive is the #1 driver of innovation and discovery. The anti-viral pipeline is coming to an end. As more and more drugs come off patent the financial incentive for new drug discovery will dry up. This is not unique to antivirals.
Drug companies stopped researching new antibiotics decades ago. Between 1945 and 1968, drug companies invented 13 new categories of antibiotics.
Between 1968 and today, just two new categories of antibiotics have arrived.
Why? Because there is no financial incentive to do so. The money isn't in it. Once consumers shift to generic HIV drugs the pipeline will dry up as drug companies move their resources to more profitable endeavors.
Here are a couple of interesting articles about this.
http://www.washingtonpost.com/national/health-science/nih-superbug-outbreak-highlights-lack-of-new-antibiotics/2012/08/24/ec33d0c8-ee24-11e1-b0eb-dac6b50187ad_story.html
http://www.telegraph.co.uk/finance/newsbysector/pharmaceuticalsandchemicals/9010738/The-battle-to-discover-new-antibiotics.html
http://www.naturalnews.com/037009_antibiotics_superbugs_drug_companies.html
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chgo2012,
unbelievable....
I pay over 10k per year and suppose to settle for whatever the system wants just to save them some money and with "PEOPLE LIKE YOU" support....
that's the reason why the USA is behind in many things, too many sheep afraid to defend their real rights and afraid of the big ones. There's nobody paying anything for me at all.. otherwise, there's plenty of wealthy people getting treatment and pills for free around. I feel sorry for people afraid to fight getting upset for the ones that obtain what they deserve for doing so. Good lucky to you guys
Please learn to use the quote button, your posts are very hard to read.
I agree with bocker3. By insisting on overpriced brand name products that don't work any better, you are doing your part to raise healthcare prices. Just don't be too surprised or upset when the insurance raises your premium and copay.
Even $10k in annual premiums doesn't begin to pay all your healthcare expenses.
How much do you think brand-name Epzicom costs ?
Answer : $753/month
http://www.pharmacychecker.com/compare-drug-prices-online-pharmacies/Epzicom-600+-300mg/44768/77568/
That's $9K, close to your entire premium. And you have to take a 3rd HIV drug in combination with it, and labs, neither of which are free. So by taking this brand name, you already ensure that your insurance company is taking a loss on you. That means the money has to come from other healthier policyholders. So yes, somebody else is actually already paying for you, whether you realize it or not !
Since the insurance company is a business, you can be sure that they will do everything they can to get your individual premiums+copays to cover your individual costs. It is just not smart for you to insist on the brand name and maximize the overall costs when there is no therapeutic benefit to you.
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Either BigPharma will let that happen and abandon that territory to those generics manufacturers (which belong to big pharma any way) or they will match the price
If there is no price heaven anylonger, I so not see how branded meds remain on the market at that price level much long.
Those expensive branded meds can't go off patent soon enough. The price gouging is outrageous. The manufacturers are using the drugs as cash cows. The drug prices are rising far more than anything else in healthcare.
Reducing the profitability of Big Pharma will also reduce their incentives to develop new meds. Already Boehringer (manufacturer of Viramune) has announced that they are closing their anti viral teams.
This is too bad because this will affect the future of newer drugs within a given class but also that of newer, innovative new classes
It is the money that we spend on meds that fuels research.
At some point the meds will just become be good enough for most. We may already be there actually. In 17 years when all of today's meds are generics, there may not be many medical reasons to choose brand names anymore even if a few new drugs come along during that time.
Manufacturers would have to find something more compelling than today's once a day regimens to continue justifying the high prices. Maybe once a week, once a month, or once a year treatments.
Or, of course, therapeutic vaccines or a cure.
I'm not sure what portion of the money or our insurance companies and governments spend on brand name drugs actually goes to R&D. Shareholders demand profits in the form of dividends or capital appreciation. A good chunk goes to them, not R&D.
At the end I do not know whether we, as patients, will benefit from this
The status quo where so many can't afford life saving drugs is untenable. Of course many will benefit, especially the uninsured and underinsured. The ADAP budget will shrink when most patients are on generic. The expense reductions could be invested directly into research.
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unbelievable....
I pay over 10k per year and suppose to settle for whatever the system wants just to save them some money and with "PEOPLE LIKE YOU" support....
that's the reason why the USA is behind in many things, too many sheep afraid to defend their real rights and afraid of the big ones. There's nobody paying anything for me at all.. otherwise, there's plenty of wealthy people getting treatment and pills for free around. I feel sorry for people afraid to fight getting upset for the ones that obtain what they deserve for doing so. Good lucky to you guys
What "rights" exactly are you talking about here? The right for others in your insurance company to subsidize your care? Yes -- that is what insurance is supposed to do -- some use more than they pay in and some use less. Again -- our system isn't ideal, but you can't pretend that it is something that it is not.
As for "nobody paying anything for you" -- that is sheer and utter BULLSHIT. You ARE being subsidized by other Kaiser members.
So -- it is PEOPLE LIKE YOU that are the problem -- you want the best of everything (even when not warranted, medically) AND you want someone else to pay for it.
Mike
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The expense reductions could be invested directly into research.
Is there is in this world a single major politician who has turned your well wishing suggestion into a committing proposal ?
Is there a single big budget or big pocket decider who has ever offered to buy back a Big Pharma's patent to make it public domain faster ?
Any candidate to propose that gvt should compensate Merck today to make RAL (raltegravir) available as a generic as early as tomorrow?
Is drug treatment and cost any different than a pole tax on HIVERs, that eventually makes them (us) economically more challenged and demographically confined in 'minorities'
Big Pharma and insurance companies are part of the system, accomplices, but they are not the deciders
If EFV going generic can save as much as one billion dollars to the victims of HIV why does the gvt(s) not bail out patent owners (for, say, 500 millions) and save the health system?
If the health system is on the verge of bankcruptcy, why not cut the franchise duration ? Even at the expense of properly compensating Big Pharma so that they can use this sudden cash towards growing threats like Hep C?
My concern is that the historical treatment pathways (PIs, NRTIS, NNRTIs) will become anchored as the sole available treatment for the only reason that they were historically the first. As if the science of understanding the virus in depth had made no progress in the last 20 years?
The only way Big Pharma can extend its franchise is by coming with new drugs that make older drugs obsolete. And the best way to make older drugs obsolete is to make the virus more resistant with inconsiderate missusage of patent expired drugs.
With Truvada becoming an OTC drugs, who long do you think it will take to see viruses resistant to that entire class?
Now since when is Truvada an OTC ? Since anyone can go to their doctor, claims that the are in a magnetic relationship, buy their Prep for $800/month and resale it on black market for $1200/month and messing with dosage.
The expense reductions could be invested directly into research.
Agreed by HIVERs.
Approved by HIVERs.
but dismissed with applause by unconcerned bystanders
I still liked it better when R&D was made in high tech furbished Baltimore or Caltech. Now it is moving to 'emerging' R&D' centers in Swaziland or Shanghai (no discrimination intended)...
Eric
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Is there is in this world a single major politician who has turned your well wishing suggestion into a committing proposal ?
No, but very few useful HIV meds have gone off-patent at this point in time. The savings for insurance companies and governments are still many years away.
Is there a single big budget or big pocket decider who has ever offered to buy back a Big Pharma's patent to make it public domain faster ?
Any candidate to propose that gvt should compensate Merck today to make RAL (raltegravir) available as a generic as early as tomorrow?
That is a completely different topic. I only suggested that after the meds go off-patent, governments continue spending the same amount of money that they already spend into programs like ADAP, but invest the money into research instead of reducing the HIV/AIDS related spending. I did not say that this would happen overnight.
Is drug treatment and cost any different than a pole tax on HIVERs, that eventually makes them (us) economically more challenged and demographically confined in 'minorities'
I don't follow you at all.
Big Pharma and insurance companies are part of the system, accomplices, but they are not the deciders
They have bought enough of the congress that they effectively decide. Our government won't even bargain for drug prices.
If EFV going generic can save as much as one billion dollars to the victims of HIV why does the gvt(s) not bail out patent owners (for, say, 500 millions) and save the health system?
If the health system is on the verge of bankcruptcy, why not cut the franchise duration ? Even at the expense of properly compensating Big Pharma so that they can use this sudden cash towards growing threats like Hep C?
I think your premises are wrong, so the solutions you propose do not follow.
My concern is that the historical treatment pathways (PIs, NRTIS, NNRTIs) will become anchored as the sole available treatment for the only reason that they were historically the first. As if the science of understanding the virus in depth had made no progress in the last 20 years?
Oh come on now ! 20 years ago was 1992, there were no known working treatments, combination therapy was not there yet. Plenty of progress has been made since. The list of classes of drugs is much longer than what you say.
See http://en.wikipedia.org/wiki/Antiretroviral_drugs#Classes_of_drugs
The only way Big Pharma can extend its franchise is by coming with new drugs that make older drugs obsolete. And the best way to make older drugs obsolete is to make the virus more resistant with inconsiderate missusage of patent expired drugs.
This is extremely cynical. I completely disagree this is the best way. They can make older drugs obsolete by having better treatments with fewer side effects, and perhaps longer lasting in the body which would allow treatments to be less frequent instead of once a day. I am not bothered by it but I know many people don't like to take pills daily. If I want to visit an unfriendly country for 2 weeks and I don't have to take my HIV meds and incur the risk of being sent back, that's a big plus.
With Truvada becoming an OTC drugs, who long do you think it will take to see viruses resistant to that entire class?
Truvada is not becoming an OTC drug, so once again your premise is wrong.
Now since when is Truvada an OTC ? Since anyone can go to their doctor, claims that the are in a magnetic relationship, buy their Prep for $800/month and resale it on black market for $1200/month and messing with dosage.
That is not my definition of an OTC drug. The resale of the drug would be a felony.
I agree there are issues with Truvada PrEP and resistance, and I hope doctors are not hasty prescribing the drug, and patients on PrEP get the required followup. This has nothing to do with the issue of generics vs brand name.
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They have bought enough of the congress that they effectively decide. Our government won't even bargain for drug prices.
Untrue. The Ryan White Fund and Medicaid negotiate on State and Federal levels for lower drug prices all the time. RW, in particular. has negotiated within the last two years for million of dollars off the regular prices allowing a huge clearing of the ADAP waiting lists back in the Spring.
That premise (of negotiation) is why the Single Payer Method has proof of working by how Medicaid and ADAP pay less for medications. ;)
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leatherman,
Untrue. The Ryan White Fund and Medicaid negotiate on State and Federal levels for lower drug prices all the time. RW, in particular. has negotiated within the last two years for million of dollars off the regular prices allowing a huge clearing of the ADAP waiting lists back in the Spring.
That premise (of negotiation) is why the Single Payer Method has proof of working by how Medicaid and ADAP pay less for medications. ;)
Thanks for correcting me, I didn't know Ryan White and Medicaid did that. I know Medicare part D does not.
As for the Single Payer Method, it has worked in so many other countries, the proof that it works was provided a long time ago.
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That is not my definition of an OTC drug.
Wait until you see Truvada as easy to find as illegal drugs in the US , just asking some fellow around the corner
So not over the counter, but Off The Corner.
It would be interesting to learn if generics availability can be linked to an increase in resistance. I'll check the available lit. what what they say about countries such as South Africa or neighbouring countries
Eric
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BugInMe: I agree with your statement: Incentive is the #1 driver of innovation and discovery. The anti-viral pipeline is coming to an end. As more and more drugs come off patent the financial incentive for new drug discovery will dry up. This is not unique to antivirals.
However, I take a different perspective. HIV has a LOT of room to improve treatment beyond antivirals. I see the anti-viral pipeline as a disincentive to bring forth the next generation of HIV drugs. Once the anti-virals are all generic, a new generation of HIV drugs has the potential to render them obsolete. Given the knowledge being acquired about HIV, I don't see HIV drug research going the way of antibiotics.
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So one working at big Pharma told me a double blinded full fledged clinical trial costs around 800 million US Dollars.
I hope they can reduce that cost with 'generic' clinical trials ;-)
ERic
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Wait until you see Truvada as easy to find as illegal drugs in the US , just asking some fellow around the corner
So not over the counter, but Off The Corner.
In other words, BS. By your definition, any drug is OTC since people who have prescriptions could choose not to take them and sell them illegally. I still don't see a point.
It would be interesting to learn if generics availability can be linked to an increase in resistance. I'll check the available lit. what what they say about countries such as South Africa or neighbouring countries
It doesn't even seem interesting to research. You are mixing up generics and OTC drugs.
HIV drugs, whether generic or brand name, are still by prescription only here, and I don't think it's any different in South Africa.
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So one working at big Pharma told me a double blinded full fledged clinical trial costs around 800 million US Dollars.
I hope they can reduce that cost with 'generic' clinical trials ;-)
B.S. again, one clinical trial does not cost anywhere near that much.
Go to http://www.clinicaltrials.gov/ . First line says that there are 134,739 studies in progress.
$800 million x 134,739 is $107.79 trillions.
The entire US GDP is "only" about $15 trillions.
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try these:
http://www.irinnews.org/report/95507/HEALTH-Cost-of-clinical-trials-worries-donors
and this
http://www.pharmalot.com/2011/07/clinical-trial-costs-for-each-patient-rose-rapidly/
and redo the maths for us, if you please (or if you can)
Thanks
eric
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estimate of cost for phase 3 trial for approval of Quad:
number of participants: 708
source
http://www.retroconference.org/2012b/Abstracts/43391.htm
cost per patient: 40 k
source
http://www.marketwire.com/press-release/per-patient-clinical-trial-costs-rise-70-in-three-years-1538269.htm
that is already 28 million USD for one trial
multiply by around 3 to take into account phase 1, 2 and 4 this is ca. 100 million
not to mention the trials for each individual component (elvitegravir and cobicistat)
Hope this helps
Eric
PS: this is of interest to:
http://hivdb.stanford.edu/surveillance/map/
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try these:
http://www.irinnews.org/report/95507/HEALTH-Cost-of-clinical-trials-worries-donors
and this
http://www.pharmalot.com/2011/07/clinical-trial-costs-for-each-patient-rose-rapidly/
These are the total costs of drug development, not the costs of an individual clinical trial. Apples and oranges.
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estimate of cost for phase 3 trial for approval of Quad:
number of participants: 708
source
http://www.retroconference.org/2012b/Abstracts/43391.htm
cost per patient: 40 k
source
http://www.marketwire.com/press-release/per-patient-clinical-trial-costs-rise-70-in-three-years-1538269.htm
that is already 28 million USD for one trial
Right, 28 million, not 800 millions .
PS: this is of interest to:
http://hivdb.stanford.edu/surveillance/map/
Of interest, yes.
But irrelevant to the issue of generics vs brand name drugs.