Anyone Retire on an Expensive Medicine

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Scott 2
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Anyone Retire on an Expensive Medicine

Post by Scott 2 »

Wife started taking Humira. Twice a month shot, now that the deductible is hit, she pays $5 a month.

The shot is $1000 a dose otherwise.

With my cushy full time job and premium health insurance, it's no big deal. Obviously needing the drug is bad, but money is irrelevant.

On retirement dollars, there's a whole different story. Best case, a couple grand to hit the deductible every year. Annoying, but manageable. Save another $100k.

Worst case, healthcare reform means that $24k a year in medicine is coming out of pocket and we are begging the drug company for subsidy. Or maybe paying sky high underwritten premiums.

The latter risk adds a huge disincentive to retiring while I've got a good thing going at work. Curious how/if others have navigated.

ThisDinosaur
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Re: Anyone Retire on an Expensive Medicine

Post by ThisDinosaur »

No, but the fear of developing an expensive chronic condition post-retirement is gonna keep me working longer.

Someone in the obamacare thread made the point that "insurance" should be purchased for problems you don't have yet, but *could* happen to anyone. Insurance, then, is probably not how you should approach a problem you already have. The options appear to be 1) work/save more to account for this known retirement expense or 2)find a way to reduce the expense.

Do you mind sharing what the drug is prescribed for? Have you asked the doctor if there is a cheaper alternative?

ThisDinosaur
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Re: Anyone Retire on an Expensive Medicine

Post by ThisDinosaur »

Here, I was looking for this:
http://www.huffingtonpost.com/david-bel ... 37542.html
As you can see, both medications cost less than the copay, meaning the insurance company wasn’t actually being asked to “cover” anything. In fact, the one I prescribed was the cheaper of the two...could have bought the medication herself — for less money than the copay her insurance plan required, she couldn’t do it at Walgreens. At most chain pharmacies, if you show them an insurance card, you’re forced to play by your insurance company’s rules.
It's by the same doctor who runs the http://truecostofhealthcare.net/medications_ii/ blog, also posted in the obamacare thread.

Bottom line, you can often save money on medications by NOT involving your insurance company. Sometimes a *lot* of money.

George the original one
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Re: Anyone Retire on an Expensive Medicine

Post by George the original one »

When it's a necessary reoccurring prescription, check in Canada & Mexico for better deals. Downside is you won't have the same consumer protection, though Canada has a solid reputation.

George the original one
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Re: Anyone Retire on an Expensive Medicine

Post by George the original one »

Another thought: with an expensive medication, a low deductible insurance plan might be a better bargain. Confirm that the medication is on the supported list for that plan.

George the original one
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Re: Anyone Retire on an Expensive Medicine

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IlliniDave
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Re: Anyone Retire on an Expensive Medicine

Post by IlliniDave »

ThisDinosaur wrote:
Sun May 28, 2017 9:57 am
No, but the fear of developing an expensive chronic condition post-retirement is gonna keep me working longer.
This is more and more becoming a concern for me. At least with ACA you had some idea of the upper bound you'd hit in a given year. If AHCA goes into effect, a situation like the OP might mean that for all intents and purposes no insurance is available, especially in transition from an employer plan to the individual market, until you are destitute enough to qualify for Medicare in your state. This leaves a person exposed not only to the pre-existing chronic condition, but also to all the unexpected things that could occur in the future. It's a real buzzkill when you are starting to get all excited about the possibility of early retirement.

classical_Liberal
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Re: Anyone Retire on an Expensive Medicine

Post by classical_Liberal »

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Last edited by classical_Liberal on Thu Feb 04, 2021 11:11 pm, edited 1 time in total.

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jennypenny
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Re: Anyone Retire on an Expensive Medicine

Post by jennypenny »

We are on some expensive meds here (over $1K/month retail, sometimes over $2K). When we didn't have good coverage, either because the plan that year wasn't good or because the meds weren't covered, we were able to negotiate lower costs directly with the manufacturer. They pad costs with insurers but are pretty helpful if you don't have good coverage. Be aggressive, both with suppliers/producers and with doctors to get them to find an alternative that is cheaper. Getting into trials can also help.

I have heard that 'life-saving' drugs (like AIDS drugs) are harder to negotiate. I guess they figure they've got you if you'll die without the meds.

@Scott -- It depends why your wife is taking humira too. I know of people who got bumped from coverage because they had Crohn's, but I could get coupons from the manufacturer because I needed it for psoriasis. (wasn't a candidate in the end) In your case, you might end up having to find a doctor who will work with you to make sure you wife has the best diagnosis listed to make sure it's covered.

Dragline
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Re: Anyone Retire on an Expensive Medicine

Post by Dragline »

Not personally, but this issue has driven at least one relative to apply for disability primarily to cover the meds.

Sorry about your situation. Yet another failure of the US healthcare system.

OT, I'm always surprised (maybe I shouldn't be) by the numbers of people on daily meds. We are not on anything everyday (yes, we're >50). This seems to be the exception now rather than the rule. I keep wondering when the rules changed.

Scott 2
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Re: Anyone Retire on an Expensive Medicine

Post by Scott 2 »

I appreciate the input. I always had this as a risk in the back of my mind. Half my “FI” budget is insurance and medical expenses. I suspected even that might be low.

The condition is a form of auto-immune arthritis (ankylosing spondylitis). Other auto-immune conditions run in her family, so it's not too unexpected. Doctor is evidence based, her treatment pattern aligns with the white papers I could find, which the doctor willingly reviewed with me. She even entertained my “lifestyle intervention” chain of thought, clearly explaining the risks. At one point, she walked us through prepping an injectable form of methotrexate at $30 a month, instead of a $500 per shot auto-injectable, that was not covered by insurance. I believe she’s cost conscious.

On the pro side, the drug is expected to take the condition from something that literally cripples you, to a managed source of pain. Twenty years ago, prognosis would be completely different. It’s close to an “any price” type of drug, IMO.

Delivery is interesting - it must be kept cold, and comes from a specialty pharmacy. They literally courier it to your door each month, within an agreed upon 2-hour window. The class of drug is a biologic. I believe that means it has very specific handling guidelines to ensure efficacy. Makes mail order a little harder.

The patient assistance link George provided is the type of subsidy program I am referring to. We have the card; the drug company even provides a nurse. She performed a home visit to train on taking the initial dose, and can be called with questions. I have not found a reliable source of costs for the under-insured, but I have not looked very hard. Up until 6 months ago, I just assumed we’d eventually be low income on an ACA subsidy.

The courier delivery and on call nurse must factor into cost somehow. I have not seen an option to decline those premium services for a lower price. Obviously, there is profit being made.

The other side of doling out an expensive drug, is the doctor’s appointments that go with it. You don’t just get a year-long Rx at the annual checkup. I haven’t looked to see whether it’s the drug or the doctors and tests that got us to the deductible. It doesn’t really matter for now.

Good point on geographic arbitrage. While we have family anchoring us locally, it can always be a worst-case scenario backup plan. In the very worst case, I think we’d have enough assets and professional skills to emigrate.

I have looked into the disability angle, since a full-time job working in an office environment would be tough. Currently she’s working full-time from home, with flexible hours, which is manageable. Pain comes and goes in flares. She’s reluctant to be flagged as disabled. Were the work from home option not available, I would push exploring it harder. From what I have investigated, I believe it would be possible for her to qualify, but it is a multi-year process. Sustaining eligibility also requires a very low earning ceiling, which precludes even limited part-time work. I think the couple yoga classes she teaches a week would bump her out of the pool, for instance.

Another consideration I’ve looked at, is trying to estimate when a bio-similar drug might come on the market. This is a guessing game, and the price would still be unclear. But I could project a 30-year cost till Medicare, in a variety of price scenarios. One article suggests 2022:

https://www.nytimes.com/2016/07/16/busi ... .html?_r=0

Part of me wonders if this is a “run faster than the next guy” scenario, that doesn’t require much worry. Even if failure of the social safety nets is a risk, maybe having some money and a lot of smarts is enough to avoid the fallout, even with an expensive chronic condition.

For now, I’m sitting tight to see what happens with ACA/AHCA. It puts me in this weird situation where my net worth is increasing at 90% of my annual salary, I have a low SWR, but yet I have major financial risk. I feel fortunate to enjoy my current profession.

Dragline
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Re: Anyone Retire on an Expensive Medicine

Post by Dragline »

Thanks for sharing. I think these kinds of situations are more common than most people like to think. Too easy to wave our hands and pretend they don't exist. Medical expenses were the #1 reason for personal bankruptcy before ACA and they are reduced now, but still up there.

Lemon
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Re: Anyone Retire on an Expensive Medicine

Post by Lemon »

I wouldn't bank on the patents finishing any time soon given how poor a lot of companies drug pipelines are looking. Extending patents is pretty much always cheaper than making something new let alone better. Biosimilars give a more legitimate reason than normal drugs too, sort of. Eventually I would have thought public opinion might mean cost saving takes priority but then US and healthcare never seem to make cultural sense to me.

As @scott mentioned, not a very heat stable product either

@dragline very true. And by some joke of the universe part it is conditions which are rather non modifiable from a lifestyle point of view that have some of the most expensive biologic treatments.

IlliniDave
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Re: Anyone Retire on an Expensive Medicine

Post by IlliniDave »

Having to spend my retirement haggling with drug companies and declining better treatment because of costs certainly isn't my dream retirement. The latter seems like it would always be my approach. I guess I can cross my fingers and hope nothing comes up between now and 65, though in reality those seem like long odds. I wouldn't be the only person I know who worked longer than they may have had to for the sake of medical coverage.

Scott 2
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Re: Anyone Retire on an Expensive Medicine

Post by Scott 2 »

I get it, the drug companies exist to make a profit. We had some bad luck, now it's a question of optimizing to the system that is.

ACA subsidy is the first line of defense. It's at risk, so what's next?

Did a little more research. It looks like the sweet spot for patient assistance is 100-300% of the federal poverty line. Too little income and they send you to Medicaid. For a two person household, that looks like 16-48k a year. I think you have to requalify every year. Certainly I'll explore that at the time, and it gives further incentive to line up a retirement date with a year end. Living a low expense lifestyle is ideally suited to take advantage of this, but it is "charity" outside our control. Practically, I see it as a drug company business strategy to keep government regulation away, so it could be very stable.

Moving to a state that keeps ACA type benefits in the event of AHCA is a consideration, though I would hesitate, under expectation that many do the same. It would mean committing to moving to the optimal risk pool as political sands shift.

While not available in the US, the biosimilar appears to be on market internationally, at around $100 a dose. Switching medicines is always a risk, so I don't love this option. Also, as of today I'd rather work than emigrate, but it's a final safety net.

Scott 2
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Re: Anyone Retire on an Expensive Medicine

Post by Scott 2 »

It seems I completely misunderstood how billing for the Humera works. In reviewing my HSA, I discovered that despite having a high deductible health plan, we have never paid more than $5 a shot, and medical expenses for the year are just over $1000 billed. My wife handles her medical stuff - I must not have been listening closely enough.

I really don't understand how the insurance company is paying out while avoiding my deductible. Either the discount card is just a really sweet thing to have, or we'll have a giant bill show up one day...

Riggerjack
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Re: Anyone Retire on an Expensive Medicine

Post by Riggerjack »

I really don't understand how the insurance company is paying out while avoiding my deductible. Either the discount card is just a really sweet thing to have, or we'll have a giant bill show up one day...
Many insurance plans consider drugs as a separate category when calculating deductibles. For instance, my plan covers generics 100%, and doesn't wait on the deductible to pay that cost.

Scott 2
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Re: Anyone Retire on an Expensive Medicine

Post by Scott 2 »

Good point, I'll need to figure out what my prescription drug benefit is, the pricing must relate to that somehow.

I'm grateful to have affordable access to life changing medical care, but the pricing complexity really does get frustrating.

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jennypenny
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Re: Anyone Retire on an Expensive Medicine

Post by jennypenny »

Not only do they tinker with our plan every year, the prices on medications through our prescription plan change quarterly. So annoying.

I should have mentioned that the best source of help and information has been our pharmacist.

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