Why a patient paid a $285 copay for a $40 drug | PBS NewsHour

Liu and her husband Z. Ming Ma, a retired physicist, are insured through an Anthem Medicare plan. Ma ordered the telmisartan through Express Scripts, the company that manages pharmacy benefits for Anthem and also provides a mail-order service.

The copay for a 90-day supply was $285, which seemed high to Ma.

“I couldn’t understand it — it’s a generic,” said Ma. “But it was a serious situation, so I just got it.”

A month later, Ma and his wife were about to leave on another trip, and Ma needed to stock up on her medication. Because 90 days hadn’t yet passed, Anthem wouldn’t cover it. So during a trip to his local Costco, Ma asked the pharmacist how much it would cost if he got the prescription there and paid out of pocket.

The pharmacist told him it would cost about $40.

“I was very shocked,” said Ma. “I had no idea if I asked to pay cash, they’d give me a different price.”
— Read on www.pbs.org/newshour/health/why-a-patient-paid-a-285-copay-for-a-40-drug

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Flagler Hospital uses AI to create clinical pathways that enhance care and slash costs | Healthcare IT News

Flagler Hospital in Saint Augustine, Florida, is using artificial intelligence tools to improve the treatment of pneumonia, sepsis and a dozen other high-cost, high-mortality conditions. Usually, it’s large academic medical centers or wide-ranging health systems, not community hospitals, that so aggressively use AI in attempts to improve care and trim costs.

The AI tools automatically revealed new, improved care pathways for pneumonia and sepsis after analyzing thousands of patient records from the hospital and identifying the commonalities for those with the best outcomes. The hospital quickly implemented the new pneumonia pathway by changing the order set in its Allscripts EHR.

It expects to save $1,356.35 per pneumonia patient in direct variable costs (35 percent savings) versus the status quo, while reducing length of stay by two days. The new sepsis pathway has also been deployed.

— Read on www.healthcareitnews.com/news/flagler-hospital-uses-ai-create-clinical-pathways-enhance-care-and-slash-costs

Suicidal Vet Calls MDMA Treatment ‘a Miracle’

Suicidal Vet Calls MDMA Treatment ‘a Miracle’
He suffered from post-traumatic stress disorder after the Iraq War. Thanks to MDMA, Jonathan Lubecky finally feels like he’s recovering.

THOR BENSON
08.16.18 5:12 AM ET
Jonathan Lubecky is a 41-year-old veteran who, until a few years ago, suffered from a severe form of Post-Traumatic Stress Disorder (PTSD). Lubecky attempted suicide five times after he was discharged from the Army in 2009.

“My unit there knew there was something off with me while I was deployed, but it didn’t really become noticeable to me until after I got home. That’s when I started having a lot of problems,” Lubecky told The Daily Beast. “My first suicide attempt was on Christmas Eve/Christmas morning in 2006—right after I got back.”

Lubecky felt hopeless, so the drug he credits for saving his life might come as a surprise: MDMA, the purest form of the club drug often referred to as ecstasy, or molly.
— Read on www.thedailybeast.com/suicidal-vet-calls-mdma-treatment-a-miracle

San Francisco hospital treated Korean tourists’ baby with a nap and a bottle of milk formula. The bill was US$18,000 | South China Morning Post

San Francisco hospital treated Korean tourists’ baby with a nap and a bottle of milk formula. The bill was US$18,000 The case of baby Park Jeong-whan, who bumped his head, highlights the growing tendency of US hospitals to charge ‘trauma response fees’ that go into effect regardless of the eventual treatment and run as high as US$51,000 On the first morning of Jang Yeo-im’s vacation to San Francisco in 2016, her eight-month-old son, Park Jeong-whan, fell off the bed in the family’s hotel room and hit his head.

Source: San Francisco hospital treated Korean tourists’ baby with a nap and a bottle of milk formula. The bill was US$18,000 | South China Morning Post

There’s a Cure for Hepatitis C, but Insurance Companies Don’t Want to Pay for It

True cures in medicine are surprisingly rare. But for nearly five years, doctors have had one available for hepatitis C, an often chronic, life-shortening viral disease that wreaks havoc on the liver. The only problem, as a depressing study published Thursday in Open Forum Infectious Diseases highlights, is that… Read more…

Source: There’s a Cure for Hepatitis C, but Insurance Companies Don’t Want to Pay for It