Hump Day

ei34

Getting closer to the end of this week, phew.  The holiday concert was nice, just a late night.  Tonight is oldest's concert.  Should be equally enjoyable/tiring.  
Hope you're all doing okay!

levioosa

Have a great time at the concert!  

Tired today. The girl cats woke me up fighting in the middle of the night. So annoying. And then I had a very weird, very disconcerting dream and my headspace is a little off now. Trying to decide if I should push to move a day off or if they will be upset if I ask. We also work a full day Christmas Eve and tbh I think that's bullshit. Otherwise, SSDD. Making some tentative weekend plans and hoping they go successfully. 

I got a Merry Christmas to Meeee gift last night and I'm excited about it. H can use it too and it's a really useful thing, but it wasn't cheap. It's an adjustable workout kit and I use it at the gym all the time, but getting to the gym has been really hard with the new schedule changes. I'm tired of not working out like I normally do. So hopefully this helps. H was actually impressed with it last night. I didn't think he'd be too blown away, so that was nice. 

VarunaTT

IDK what is up with this week, but I'm just in a funk.  

Taking one of my good friends out to dinner next week for his Christmas present.  He is one of those "loves the cold" people and will wear shorts almost every day unless it snows.  Maybe jeans if it gets under 40 degrees.  I had mentioned a fine dining steakhouse that is delicious, but just asked if he wanted to go to our regular steakhouse, "So you don't have to wear pants".  Waiting on his response.  

Other than that, SSDD really.  I've volunteered to have a kit sent to me to put together and then shipped to a company that uses the kits for teens in the hospital for mental health.  I miss volunteering, but I still get anxious when I think about it, so this will be a nice, easy "don't have to interact with people" version of it.

banana468

I'm feeling a funk too.  I love the holidays but I think I feel pressure so that creates anxiety and that creates funk.  

It's cold today and my space heater isn't doing it!  I am going to need to deal with just turning on my electric heat in my office or my shoulders are going to be so high they'll be stuck in my earlobes.

levioosa

VarunaTT said:

Taking one of my good friends out to dinner next week for his Christmas present.  He is one of those "loves the cold" people and will wear shorts almost every day unless it snows.  Maybe jeans if it gets under 40 degrees.  I had mentioned a fine dining steakhouse that is delicious, but just asked if he wanted to go to our regular steakhouse, "So you don't have to wear pants".  Waiting on his response.  

Ew. lol. I literally can't imagine. I can't even stay inside my 68 degree house in the winter without the heated blanket underneath me. 

VarunaTT

levioosa said:

VarunaTT said:

Taking one of my good friends out to dinner next week for his Christmas present.  He is one of those "loves the cold" people and will wear shorts almost every day unless it snows.  Maybe jeans if it gets under 40 degrees.  I had mentioned a fine dining steakhouse that is delicious, but just asked if he wanted to go to our regular steakhouse, "So you don't have to wear pants".  Waiting on his response.  

Ew. lol. I literally can't imagine. I can't even stay inside my 68 degree house in the winter without the heated blanket underneath me. 

When I go over to his house, he always turns on the heater for me and usually has a blanket ready.  His cat and I snuggle underneath it.   

MyNameIsNot

I'm just exhausted today and don't know why. I got enough sleep last night, but it somehow just isn't enough. I'm thinking maybe it's the cold and just general dread that just is. 

Have you all seen this united CEO thing? Wondering if someone just totally lost it with insurance companies denying people care. 

Nothing much else going on. We're going to a bourbon tasting tonight, so that should be fun. 

levioosa

@MyNameIsNot my grandma just told me about it. It was super targeted. People are so angry and I don't blame them (doesn't make murder right, of course). Could have been someone upset about their coverage, could have been one of the many many companies that UH put out of business with the shady Change Healthcare hacking and acquisitions, could just have been someone mad at the world. But uh, UH is not known for being great and patient centered.  

short+sassy

levioosa said:

@MyNameIsNot my grandma just told me about it. It was super targeted. People are so angry and I don't blame them (doesn't make murder right, of course). Could have been someone upset about their coverage, could have been one of the many many companies that UH put out of business with the shady Change Healthcare hacking and acquisitions, could just have been someone mad at the world. But uh, UH is not known for being great and patient centered.  

As much as I despise medical insurance and pharmaceutical companies because they are the apex of evil.  I would never condone any of those employees, even the big wigs, being harmed.  None of them deserve that, even though the companies' business practices do kill people.  It's not like violence is going to change those policies anyway.

But am I really that surprised the CEO of one of these companies was targeted and killed?  I am not.  I'm actually surprised it doesn't happen more often.

levioosa

short+sassy said:

levioosa said:

@MyNameIsNot my grandma just told me about it. It was super targeted. People are so angry and I don't blame them (doesn't make murder right, of course). Could have been someone upset about their coverage, could have been one of the many many companies that UH put out of business with the shady Change Healthcare hacking and acquisitions, could just have been someone mad at the world. But uh, UH is not known for being great and patient centered.  

As much as I despise medical insurance and pharmaceutical companies because they are the apex of evil.  I would never condone any of those employees, even the big wigs, being harmed.  None of them deserve that, even though the companies' business practices do kill people.  It's not like violence is going to change those policies anyway.

But am I really that surprised the CEO of one of these companies was targeted and killed?  I am not.  I'm actually surprised it doesn't happen more often.

I bet we would be shocked by all of the thwarted assassination attempts to CEOs if we knew about them. Like you think Jeff Bezos hasn't escaped more than a few? I highly doubt it. 

banana468

I remember fighting with them over just one rejected invoice knowing it would be cleared but it was massive annoyance.  I can only imagine what others go through with the nightmares I see.   Murder is never the answer but the system is so broken. 

short+sassy

On a lighter note for this subject...and I apologize if I already talked about it.

But Eli Lilly's stock tanked after their third quarter earnings call.  It's probably already recovered, I haven't checked lately.  They had record breaking net profits in the third quarter.  They just weren't as record breaking as expected.

I'm playing my tiniest violin they only earned 970.3M in PROFIT...not gross sales...over three months.

Their CEO addressed it and one of the reasons he cited for them not meeting expectations is their Zepbound sales had lagged more than expected.  I don't know if the bigwigs at EL are genuinely confused about this or pretend to be for their investors.  He said they would be addressing this with a bigger marketing campaign for Zepbound in the coming months.

Here's the difference and it's really obvious.  Mounjaro is FDA approved to treat T2 diabetes, so medical insurance will generally cover it.  Zepbound is FDA approved to treat obesity.  Exceedingly few medical plans cover any kind of treatment for obesity.

I guess from their ivory towers they are so out of touch from reality, they think lots of people can afford to and will pay the $1,000+/month retail cost for Zepbound.  Some people will.  But yeah, duh.  It's obviously not as many as they think.

It reminded me of that popular Arrested Development meme with, "It's one banana, Michael.  What could it cost, $10?"

short+sassy

levioosa said:

short+sassy said:

levioosa said:

@MyNameIsNot my grandma just told me about it. It was super targeted. People are so angry and I don't blame them (doesn't make murder right, of course). Could have been someone upset about their coverage, could have been one of the many many companies that UH put out of business with the shady Change Healthcare hacking and acquisitions, could just have been someone mad at the world. But uh, UH is not known for being great and patient centered.  

As much as I despise medical insurance and pharmaceutical companies because they are the apex of evil.  I would never condone any of those employees, even the big wigs, being harmed.  None of them deserve that, even though the companies' business practices do kill people.  It's not like violence is going to change those policies anyway.

But am I really that surprised the CEO of one of these companies was targeted and killed?  I am not.  I'm actually surprised it doesn't happen more often.

I bet we would be shocked by all of the thwarted assassination attempts to CEOs if we knew about them. Like you think Jeff Bezos hasn't escaped more than a few? I highly doubt it. 

For sure!  I'd think most of those people have bodyguards.

I watched a True Crime show about an Exxon executive who was kidnapped and held for ransom.  They kidnappers didn't mean to kill him, but he ended up dying anyway.  They were holding him in an outdoor shed, but didn't realize how hot it got inside during the day.  Not so hot it would have killed everyone.  But he was an older guy who wasn't in the best health.  If I'm remembering correctly, the stress to his body from the heat caused him to have a fatal heart attack.

The handful of other Exxon people who were his level or higher all had body guards.  He was the only one who would use a body guard when he was in a foreign country, but refused to have one when he was back home in the States.  That's why the kidnappers chose him.

It wasn't anything personal against that particular guy or even Exxon the company.  It was just about the ransom money.

VarunaTT

One of the things I have been reminding people of since TGF's first term was that the labor union wars were horrible and people died.  A lot of people, on both sides.  Desperation from an unjust system will equal violence.

I don't condone it; I'm on the other side of playing inside the system to force change.  It's blatantly naive and unrealistic to say that we don't need all sides.  I don't mourn the man who put into place an AI system that rejects 90% of claims, inaccurately, and is probably responsible of the death of hundreds and horribly changed lives for hundreds more. I can't find one ounce of sympathy for him or his family (Serena Joy is real).  I really don't have any joy or sympathy about the issue; more of a dread that America.  Is.  Here.  AGAIN. and how we all live through it.

levioosa

VarunaTT said:

One of the things I have been reminding people of since TGF's first term was that the labor union wars were horrible and people died.  A lot of people, on both sides.  Desperation from an unjust system will equal violence.

I don't condone it; I'm on the other side of playing inside the system to force change.  It's blatantly naive and unrealistic to say that we don't need all sides.  I don't mourn the man who put into place an AI system that rejects 90% of claims, inaccurately, and is probably responsible of the death of hundreds and horribly changed lives for hundreds more. I can't find one ounce of sympathy for him or his family (Serena Joy is real).  I really don't have any joy or sympathy about the issue; more of a dread that America.  Is.  Here.  AGAIN. and how we all live through it.

I was just talking to H about this last night. How basically every time there has been a big social change it has been because people were desperate, and violent. So many people lost their lives to make unions a reality. And it wasn't until the workers got violent that real changes were made. I don't condone violence at all, but I'm not naïve to think that change will just magically happen without some sort of impetus, and people's "good natures" are not prevailing. A few years ago bff and I got into a huge fight about the George Floyd protests, where she was spouting some racist BS and I was like, what do you expect? People are disenfranchised, tired, beaten down, and they are angry. I don't approve of vandalism and of course there were some people completely unrelated to the cause taking advantage, but the hurt was (is) deep and I don't blame them. I'd be smashing the fuck out of windows too. 

And I'm with you on the sympathy for the CEO. I know it probably says something about me as a person, but I read her statement and I felt absolutely nothing. You think it was senseless? You think he was an above board good man? You think he didn't know 100% about all of these awful policies which deny patients care and burn out their providers? People died, many many people. People have suffered needlessly. I 100% do not believe that you can be worth that much and put policies like that into place and remain a good person. I'm not happy he died, I feel so empty inside, our country is so broken. 

short+sassy

NGL, I was enjoying the "medical insurance themed" social media posts people used to express their feelings about his murder.

My personal favorite was "this has not met the deductible for me to give a shit".

But my favorite more serious thought talked about how we clearly see a crime like this with a gun as a murder.  But it's more important we stop ignoring mass murders, just because it's done with computers and algorithms.  

VarunaTT

The other stream starting to happen is "why does this dude get a manhunt and [fill in victim that isn't millionaire cishet white man] by NYPD.

And DESERVED.

banana468

I'm kinda grasping here but the only thing that sticks out in the manhunt defense to me is if this is a person who is targeting possibly more CEOs / high profile executives?  

No idea what the actual deal is here but if I was the CEO of BC/BS or other well-hated insurance companies and at the holiday season what if the shooter isn't such a great shot if there are other people to be targeted? 

Based on the way this person opted to do it it seems unlikely but hey I'd like to make sure that we aren't seeing a spiral. 

levioosa

banana468 said:

I'm kinda grasping here but the only thing that sticks out in the manhunt defense to me is if this is a person who is targeting possibly more CEOs / high profile executives?  

No idea what the actual deal is here but if I was the CEO of BC/BS or other well-hated insurance companies and at the holiday season what if the shooter isn't such a great shot if there are other people to be targeted? 

Based on the way this person opted to do it it seems unlikely but hey I'd like to make sure that we aren't seeing a spiral. 

I was telling H, I am a little scared. We just acknowledged the anniversary of a terrorist attack that was near my current work and that was healthcare related. I am always thinking about mass shootings in the back of my mind when I am at a public place. And I think about it at work because people are so angry at healthcare and people reallllly don't like my company (and I don't blame them because I don't like it either). I am the face they see. My staff are the people telling them their referrals were denied when they come in. I have to tell them insurance won't cover a med which kept them stable for years, but I can offer a shittier med that makes their condition flare or gives horrible side effects. These CEOs are putting policies into place that harm patients directly, and place staff at risk all so their shareholders can make some extra cash for a portfolio they don't even need. I've had patients be violent. I've had patients make threats. This seemed very targeted and well thought out, but what about the person who just comes into a hospital or clinic and starts shooting because they are raging against the system? Once again, not condoning violence or murder, but just thinking about all of the ramifications. I think this person was very organized and efficient. He knew the guy's back on sight, and he cleared a jam in split seconds before escaping very efficiently. I don't think it was just some Joe Blow winging it. I would be scared if I was other CEOs. But he might have emboldened people and I don't like that. 

banana468

I'm so sorry @levioosa.  And I don't like that the guy was murdered.   I don't think that's the answer to this issue at all.  But I also think plenty of us have had tons of issues with that specific insurance provider, fully experienced their approach and know that we can lament the murder of a person while also fully believing that the same person signed off on policies that likely killed or at least lead to the slow deaths of countless lives. 

short+sassy

@levioosa, I REALLY try to keep that in mind when I'm speaking to a representative of a company I am angry with.  But I realize not everyone does and it's hard to be more rational when someone is being grossly wronged over something as important as healthcare.  Though I'm referring to words.  It's certainly even more terrifying when anger triggers people to violence.

I specifically remember the conversation when someone...I even remember her name (Sara)... from United Healthcare called me that the second PA request from my doctor to cover Mounjaro for me had also been denied.  The second one was so much more powerful than the first because I had started taking it anyway between them.  

I wasn't upset about the first PA denial.  I understood it.  I wasn't surprised by the second one, but now I was very angry because it was even stronger words from my doctor...including that I had insulin resistance...and before/after lab work with marked improvement that clearly showed how much this medication improved my health, especially my A1 c dropping a full point (7.2 to 6.2).

I mentally stopped myself from getting furious and went into "dark humor" mode instead, because I didn't want to be mean to Sara who was sympathetic and understanding during our conversation.

It was denied because Mounjaro hasn't been approved by the FDA for treatment of T1 diabetes (yeah I know, hence the second PA).  She continues with the rest of their words that really just said that same thing in emphatic ways.  Even included that it would be "irresponsible" of them to cover a medication the FDA has not approved for my condition.

As if medical insurance companies don't approve medication for off-label use all the time.  Hilariously, they were about to give me an example of that.

She told me about the consolation prize.  Metformin was included in my formulary and if my doctor gave me a prescription for that they would cover it.

After I picked my mouth up off the floor.  I couldn't help but heartily laugh for about 20 seconds.  I told Sara, "Interesting.  Because Metformin has never been approved by the FDA for treatment of T1 diabetes either.  (Switched to a feigned innocent and confused tone) So why is Metformin different from Mounjaro?"

God Bless her.  "I'm so sorry, Ms. Short+Sassy.  It doesn't have any of that information.  It just shows Metformin is in your formulary."  I think she offered to find out for me or put in a request.  LMAO.

I laughed and told her, "No, don't worry about it.  I'm yanking your chain a little.  I know EXACTLY what's different.  Metformin is an old, cheap medication.  But Mounjaro is expensive."  She laughed and said, "Probably."

JFC, her job must SUCK.  Making phone calls all day telling people why their medication is being denied.  She probably gets to make the positive calls also, but I think we all know that is the minority.  I made a point to thank her for her kindness when she knew I was upset about the news as we were ending the call.

I would still hate United Healthcare, but would have more respect for them if they just told the truth.  Mounjaro's expensive medication, girl!  We're not covering it for you because We.Don't.Have.To.

Instead of insulting my intelligence with repetitive strong words about "not approved by the FDA" while okaying another T2 medication that is also "not approved by the FDA".

levioosa

I'm sorry @short+sassy. I lose my mind with the GLP/GIP medications. They all have to be ordered a special different way depending on insurance. They always need prior auth. I have to document and redocument up the wazoo about decreasing weight, co-morbidities, risk of heart disease with continued weight gain, etc. And 8/10 times, denied. I even had a patient of BMI >50 get denied the other day. I couldn't believe that one. 

short+sassy

levioosa said:

I'm sorry @short+sassy. I lose my mind with the GLP/GIP medications. They all have to be ordered a special different way depending on insurance. They always need prior auth. I have to document and redocument up the wazoo about decreasing weight, co-morbidities, risk of heart disease with continued weight gain, etc. And 8/10 times, denied. I even had a patient of BMI >50 get denied the other day. I couldn't believe that one. 

I can imagine!  GLP-1s can be a life changing medication for so many people.  The more research that is done, the more conditions they find it helps.  They've already been FDA approved for heart health.  The insurance companies know that also.  The massive pushback from them is only the price.  And there is NO reason it needs to be as high as it is, except for greed.  You can just look at the retail prices, usually under $200, for Ozempic/Mounjaro in all the other countries they are sold in.

I also hear a lot of stories about GLP-1s or other drugs that improve people's health enough that now they don't "qualify" anymore under their insurance to keep having it covered.

Someone on my T1 diabetes subreddit was talking about their insurance has been covering their CGM for years.  But recently stopped because their insurance changed the qualification.  Now they are only covered if a person's A1c is X amount or higher.  His A1c has historically been in the 5's.  Just this weird attitude that since a person's A1c has been controlled so well in part to CGMs, then they somehow don't need a CGM anymore.

I read a person's striking story on my tirzepatide subreddit. She'd been running pre-diabetic for years and had been taking Metformin to keep it better controlled, but it was limited success and her A1c was still always in the low 6s.  She was also obese.  Her doctor felt Mounjaro would be a great option, but her A1c was never quite high enough for a T2 diagnosis and her insurance wouldn't cover it without one.  She said to herself, "Challenge accepted."

Three months before her next lab work, she stopped taking Metformin and ate more high sugar foods.  She purposely made her condition worse in the short-term, so she could get a medication that would help her more in the long-term.  I don't blame her one bit.  It was a smart play, but so sad to even have to do that in the first place, smh.  It worked.  She said since starting Mounjaro her A1cs are the best they've been in years and she's lost weight.

short+sassy

The "digging in deep" things I learn when something is important to me, lol.  This is related to what happens when a medication's patent expires and generics can become available.

The OG GLP-1 medication is liraglutide.  It started as a T2 diabetes drug (Saxenda) and was also FDA approved for "weight loss with another (list of conditions)" in 2014.  It's not as effective for weight loss as semaglutide/tirzepatide.  But it's also not too shabby and people lose 5-10% of their body weight on it.

Its patent expired in June.  I looked at prices once a generic was available, but was puzzled they were higher than I was expecting.  The brand name is around $660 and the generic is around $440.

I dug further because that wasn't making sense to me.  Aha!  For the first 6 months after a medication patent expires, only ONE company can produce the generic.  But after that, it is fair game and prices usually drop a lot further.

I'm almost to my goal weight anyway.  Once I'm there, I only need help with controlling my insulin resistance enough that I don't have to increase my insulin or make my weight maintenance harder.  Depending on how cheap the liraglutide generic gets, it might be a good option for that.  I'm going to start keeping my eye on those prices in January.