Mark Stoller and his wife, Andra, moved to Falcon with their family in 2007. Both are U.S. Air Force veterans and enjoy life with their daughters, extended family and adopted rescue dogs in Latigo. Mark is fortunate to have his wife and daughters as his muse for topics, people to meet and places to investigate.
The Healthcare Industry
By Mark Stoller
Happy New Year! This edition is all about health, and there are a lot of issues affecting folks on many levels.
If President-elect Trump’s administration can start working for the American people, we are going to see a big battle unfold as his pick to run the Department of Health and Human Services, Robert Kennedy Jr. takes on the National Institute of Health, the Food and Drug Administration, insurance companies and Big Pharma with his “Make America Healthy Again” campaign.
Kennedy has called for firing hundreds of people at the National Institutes of Health, removing fluoride from water, boosting federal support for psychedelic therapy, loosening restrictions on raw milk, promoting organic foods and food as medicine.
Going into this battle, always remember the Golden Rule – he who holds the gold makes the rules.
Big Pharma is one of the most powerful industries in the world. According to DrugWatch.com, the global revenue for pharmaceuticals was over $1.42 trillion in 2021. But nowhere else in the world does the drug and medical device industry have as much power and make as much money as in the U.S.
Big Pharma is also the biggest defrauder of the federal government under the False Claims Act, according to consumer watchdog group Public Citizen. The industry has a history of fraud, bribery, lawsuits and scandals.
Health insurance companies also hold the gold that regulates our lives. We pay into their coffers to represent us and help offset our medical costs. Yet, some of you may have already received letters from your health insurance carriers about what they will and will not cover in the next year.
I can’t count the number of patients I see at the hospital who come to us in crisis because they can’t afford their medications. They just do without until they are on death’s door and then come to the hospital to be made well again — until the next time.
Another patient refused the breathing treatments I offered because the inhaler he brought with him worked the best. Two days later, he approached me to say he would like to try our medications because his insurance company wasn’t going to cover Advair anymore. He was getting three months of inhalers for a co-pay of $10. Now, if he wants to continue with Advair, it’s $206 per inhaler.
Insurance companies operate based on cost and not what is best for you. They decide which prescriptions they will pay for by creating a list called a “formulary,” which outlines the medications they will cover based on factors like clinical effectiveness, cost and potential side effects. Drugs are often categorized into tiers with different copay amounts, with the most cost-effective options usually having the lowest copay, and newer, more expensive drugs placed in higher tiers, requiring a larger out-of-pocket payment.
If you do experience financial setbacks because your medications aren’t going to be covered, contact insurance brokers to find you the best coverage based on your list of medications. There are 15-plus agencies to choose from in Colorado Springs on Yelp.
Another big help in affording medications is GoodRx. They don’t negotiate on your behalf; they have arranged set prices for every prescription medication. Go to the website or app, type in your medication name and it will display the GoodRx price in your local area by store/pharmacy. I have used it several times and highly recommend it.
The original Golden Rule is “Do unto others as you would have them do unto you.” We have options and are not victims subject to the financial whims of our insurance companies.
