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Insulin Expensive

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Is My Test, Item, Or Service Covered?

How often is it covered? Medicare Part B (Medical Insurance) doesn’t cover insulin (unless use of an insulin pump is medically necessary), insulin pens, syringes, needles, alcohol swabs, or gauze. Medicare prescription drug coverage (Part D) may cover insulin and certain medical supplies used to inject insulin, like syringes, gauze, and alcohol swabs. If you use an external insulin pump, insulin and the pump may be covered as durable medical equipment (DME). However, suppliers of insulin pumps may not necessarily provide insulin. For more information, see durable medical equipment. Your costs in Original Medicare You pay 100% for insulin (unless used with an insulin pump, then you pay 20% of the Medicare-approved amount, and the Part B deductible applies). You pay 100% for syringes and needles, unless you have Part D. To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like: Other insurance you may have How much your doctor charges Whether your doctor accepts assignment The type of facility The location where you get your test, item, or service Continue reading >>

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  1. Brian_BSC

    Insulin is too expensive for many of my patients. It doesn’t have to be.
    By David M. Tridgell Washington Post, June 22 at 11:43 AM
    David M. Tridgell is a board-certified endocrinologist. He practices just outside Minneapolis.
    At age 15, I developed an unquenchable thirst and frequent urination, and lost 20 pounds. I had developed Type 1 diabetes, an autoimmune disease that destroyed my body’s ability to produce insulin. Without insulin, I would have eventually developed a condition called diabetic ketoacidosis, which is lethal without (and even sometimes with) treatment.
    Years later, I’m a practicing endocrinologist. I could never have imagined back when I first started taking insulin that one day I would have so many patients who could not afford the medication because of skyrocketing prices. When the drug was discovered in 1921, the original patent was sold to the University of Toronto for $1 so that no one else could patent it and “secure a profitable monopoly.”
    washingtonpost.com
    28

    Perspective | Insulin is too expensive for many of my patients. It doesn’t have...
    How the health-care economy squeezes diabetics

  2. David49

    He makes excellent points. A tl;dr might read as such:
    If Congress was serious about fixing drug pricing, start by doing the following:
    Eliminate tax write-offs for direct marketing of pharmaceuticals to patients;
    Eliminate direct marketing of pharmaceuticals to patients;
    Investigate price raising behavior from PBMs and pharmaceutical companies;
    Investigate rebates provided by pharmaceutical companies to PBMs;
    And allow Medicare and Medicaid to negotiate prices on behalf of taxpayers.

    That would definitely be a good place to start, and wouldn't require completely reworking the system as it is now (although I personally think the system should be completely reworked).

  3. Thas

    David49:


    And allow Medicare and Medicaid to negotiate prices on behalf of taxpayers

    I've often thought of it from a different perspective: threaten to allow Medicare to negotiate prices on behalf of taxpayers unless the drug industry reigns itself in and brings prices into line. The threat would carry significant weight, I think.

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