sailor310 wrote: ↑Sat Jan 19, 2019 7:38 am
Why would you expect an insurance company to pay for it without a prescription? If you want to be responsible for your own health (I do as well), in my opinion, you shouldn't expect someone else to pay for it. In my opinion not making an Rx required might lower the cost as you pointed out in your Nexium example.
Well...I wouldn't expect insurance to pay for it without a prescription. If you thought that was my idea...it wasn't.
My insurance has never bought me a machine.
I am actually in the "let's remove the RX sticker from cpap stuff" group.
But my Nexium point is that just because insurance pays for something doesn't mean the cost goes down IF they pay for it and it's an OTC item.
People can hope and wish all they want but that doesn't always make it happen. I would love to be proven wrong and have the prices drop significantly but I don't see it happening.....that drop if the RX requirement gets removed.
Nexium was hugely expensive prior to going OTC...and it's still hugely expensive when compared to some of the other meds in that category.
Insurance in their desire to avoid paying for anything and even less desire when it comes to an item that is OTC will simply make it unattractive to use insurance to buy any OTC item using insurance by making the patient share of the cost quite high.
For the Nexium example....insurance won't pay for Nexium in the OTC dose...simply won't cover it period. Now the twice the OTC dose (which does have a RX sticker on it) they will pay for but what they dictate as patient share of the cost ends up being more than what buying OTC and taking twice the dose to get the higher dose ends up being.
Flonase is another example...when it went OTC I go from a $8 copay to a $60 dollar copay. And somehow I don't think the wholesale price went up when it went OTC.
My point was that people tend to assume that IF insurance pays for something their out of pocket cost would be less than if they bought it OTC...and it's not necessarily the case even IF cpap went totally RX free. Insurance companies will make it really unattractive to use insurance for something that is OTC IF they even cover it at all.
Will going OTC cause a significant price drop at the retail level??? Million dollar question that we just don't know how much of an impact it would make until if/when it actually happens. Would we see ResMed AirSense 10 AutoSet machines sitting on WalMart shelves priced at $300...I doubt it. What I think we would see are the Chinese knock offs or the bricks at the more attractive prices and people won't be able to manage their own health because they won't know how.
Going OTC opens up a whole new can of worms when it comes to managing their own health and until the mindset of the medical professionals change to "let's educate the patient fully" from the "let's keep the patient in the dark and keep feeding them mushroom food...we are the all knowing gods"....it's not going to be good for the patient to simply have something be OTC with a reduced retail price. Yeah....maybe it's cheaper but what the hell do they do with it once they get it OTC?
I may have to RISE but I refuse to SHINE.
Or at least have this option available to folks that aren't savvy enough to do their own research.
- Some days sooo slow, some days just running off track ...