When I see the future, I close my eyes

[rolanni]

First, we'll take a look at the past.

In the recent past -- yesterday, in fact -- Steve celebrated the 65th anniversary of his natal day.  Here's a picture of him with a couple of party guests:

Steve (in flowered shirt), Catbus, Totoro.
July 31 2015. Picture by Sharon Lee

In keeping with the Cat Farm's well-earned reputation for housing party animals, we partied hearty.  Some of us, heartier than others:

Trooper

Sprite

Belle

Scrabble

Going a little further into the past, here's a fascinating slide show of the Baltimore that was.  I don't remember all of the places shown, but I do remember an astonishing number of them. There's even a picture of the General Motors Assembly Plant on Broening Highway, in Canton, where my father worked for many, many years, as a spot-welder.  This may be of interest to those who ask where Surebleak "came from."  It came from Baltimore, folks.

Putting our gaze now firmly on the present and near future, I have today received a notification from the people who review our health insurance provider's "formulary" that they will no longer be covering my thyroid medicine -- levothyroxine.  They will be requiring me to accept an alternate -- synthroid.  I think this is the first time in my life I've ever received such a notification from a health insurance company.  On the other hand, I'm fortunate in that I don't take very many medicines, so maybe this is A Thing.

Here's what's funny, though. When I first started with the underachieving thyroid, my doctor prescribed synthroid, which I liked as much as anyone can like a drug they have to take for a chronic medical condition.  Such relationships are, at best, complicated.  But!  The insurance company at the time did the thing that I'm Very Familiar with, that being the notification that they weren't paying for any fancy-schmancy name brand medicines.  The generic would do me -- and all the rest of the people in the network who took thyroid medicine -- just fine.  If I wanted to, I could continue with the name brand medicine, but I would pay full price for it, which I couldn't afford, so it was levothyroxine for me.

. . .which, at the time -- we're talking years ago, here -- I thought didn't work as well.  Pooh-pooh, said the insurance company, generics work just as well -- in some cases, they work better! -- than name brand medicines; stop making a fuss.

(Honestly, I was required by the day-job to attend two presentations about medications given by our then-insurance-company, and the Utter Contempt displayed for name brand medicines was really off-putting.  You'd think name brand medicines were one step below Mrs. Pinkham's Medicinal Compound.  What's with that?)

In addition, this change comes at an. . .interesting time, when we're trying to work out exactly the right dose of thyroid meds I need to function correctly, using levothyroxine, which will no longer be available to me, starting, um, today.  The letter from the formulary counsels me to get with my health care provider and have her write me a prescription for the new drug.  Which. . .OK, though that does raise the issue of cost.  It'll be hard to beat the price I paid for my last refill of levothyroxine, which was $0.

So, all of that.  Time for me to get to work, since I've already done the vacuuming.

On deck today, Author Commentary for the final chapter of Shan and Priscilla Ride Again, and more work on Droi, which will eventually be part of The Gathering Edge.

Why, yes, even in the midst of All This Excitement, we're writing a book.  Because we're just that awesome.

In order to reward the two people who managed to read all the way down to here -- I offer two songs.

The first, which brings you the title of today's blog post, Excellent Birds, Laurie Anderson and Peter Gabriel.  Here's your link.

The second comes from the Irish Rovers, Lily the Pink.  Here's that link.

Comments

[gerald heaton (from livejournal.com)]

And don't you just LOVE the so-called logic behind that change?

My retiree insurance plan requires generic when ever possible, then something called "formulary" (sort of a cross between "name brand" and "generic"), then "name brand"

I remember when they insisted that I take 3 generics (at a higher cost to them and me) than 1 "name brand" for my heart.
This change would have worked in their favor, as I was allergic the one of the suggested drugs (which, if the powers that were had read my medical file would have known and would have not lasted more than a month if I had been stupid enough to take it.
The first (and only) time I took it, it cost the insurance company 35,000.00+ for a 3 day hospital stay.

[rolanni.livejournal.com]

And don't you just LOVE the so-called logic behind that change?

What IS the logic? The letter I have here just says that they're changing the formulary, effective, August 1, would be covering synthroid,would not be covering ANY of the generics, and that the Prescription Police, or whoever they are, take A Variety of Facts into account when making these decisions, last of which is cost.

But they never actually state their reasons.

. . .it's a very Daddy Knows Best letter, so -- baffling and infuriating.

This change would have worked in their favor, as I was allergic the one of the suggested drugs

eek...

[elgordo303.livejournal.com]

Formulary (list of covered drugs) changes are generally driven by pricing agreements and benefit plan negotiations. They have nothing to do with patient safety or benefit. Cost drives everything.... as counter intuitive as it seems sometimes it's more cost effective to replace a generic with a branded drug... Especially when the formulary is crafted to favor one manufacturers products.

[aitchellsee.livejournal.com]

One wonders what Trooper and his clan would look like if anything were to afright them such that they were to puff up their Tails to appear embigganed and this more menacing?

[rolanni.livejournal.com]

Coon cat tails do get fat. . .occasionally. They really are very laid back.

The treat is when Scrabble gets a fat tail. She has a stubby an understated tail, and of course very short fur. When her tail gets fat, it swells up to three times its size, and it looks like the tail is leading the cat.

It's very hard to keep a straight face, but, of course, one must.

Bawlmer

[susan beaty (from livejournal.com)]

Thanks for the links to the Baltimore pictures. I've only lived in the area since 1997, so there were a lot of places I hadn't seen before. And there were a lot of places I had been to that are now gone (the Morris Mechanic and Marticks are two that come to mind).

Re: Bawlmer

[rolanni.livejournal.com]

You're welcome; it really is fascinating.

[attilathepbnun.livejournal.com]

A belated HAPPY BIRTHDAY!!!!!!!!!
to Steve!

[countrygirlxxoo.livejournal.com]

Before you do anything about the medicine, check with the pharmacy and see what the co-pay will be for the synthroid. Where I live (Kentucky), I use Kroger for my pharmacy. (Also, not trying to be a stalker, I checked and you have a Kroger in your town which I found on wikipedia.) I also take levothyroxine and have for years. Kroger has a low-cost generic prescription list where some drugs are $4 for a 30 day supply or $10 for a 90 day supply. Levothyroxine is on that list, so if your co-pay for the synthroid is more than $4 or $10 then stick with the levothyroxine. You can see what else is on the list if you go to www dot Kroger dot com and click the My Prescriptions link below the logo then the $4/$10 Generics link on the left of the page. Hope this helps.

[rolanni.livejournal.com]

Seriously? I don't think I've ever heard of Kroger. I'd be interested in seeing that wikipedia notation, if you have a link.

Wal*Mart -- which, sadly, we do have -- and Hannaford have the same sort of deal, though, so if I want to keep the levothyroxine, I guess I can. Unless Whatever Happened to make the formulary change its mind is going to eventually trickle down to the pharmacies, too.

It would be nice, if there were a tiny bit more information forthcoming from the decision-makers.

[countrygirlxxoo.livejournal.com]

Here's the wiki link that I found your town on. https://en.wikipedia.org/wiki/Sharon_Lee_(writer)

I looked again (on Kroger's site this time) and didn't find any evidence of a Kroger near there. I guess that's what I get for not looking deeper than the headings on a google search. LOL Anywho...like you said, Wally World and Hannaford have the same program. It's still a pain in the arse though. I don't like the Walmart pharmacy as well as the Kroger mainly because of the people who work there. The Kroger pharmacists and techs are much nicer than our Wally World staff. And they have a drive-thru window. I love that.

[elgordo303.livejournal.com]

Check with your pharmacy on the price of levothyroxine without insurance coverage... If I remember correctly oat singing like 10 or 12 dollars a month... My plan covers it so I don't rember.. But its really quite inexpensive... (Assuming my memory is good.

[star-horse3.livejournal.com]

Sam's Club also has that deal, and an even better one if you are a plus member or a veteran. I know, I know, evil thy name is... but one of my meds would have been over $1000 for 3 months without that deal at Sam's. So even if it doesn't help you too much at this particular juncture Rolanni, maybe it will help some of our other Friends. Good luck on the levo/synthroid fun and games. I am going through that too. All the best to Steve for a happy belated birthday!!

[sharon murphy karpierz (from livejournal.com)]

In fact, it depends on the generic. I learned from a pharmacist (mother of a friend) that the tolerances on some generics, like those for synthroid, are too great (if you don't do science, that means that each pill has to be between a certain amount of the required medication. A little plus or minus-- tolerance. If you do do science, I apologize). I have been on synthroid since I was 9, some 40-odd years. The one time I took a generic (student health services), I ended up so hyperthyroid that I had a migraine for a month. (Interesting to note that every one of the male doctors blamed it on the pill and told me I needed to stop taking it, even though I had been on it with no headaches for some years. The female doctor said, "Hmmm." and tested my thyroid levels.)

All this to say, yes, you will need to start over on the levels, and may need higher amounts. On the other hand, you may find that you will get more consistent relief from the brand because, again, tolerances. I pay $75 for a three month supply with no insurance support.

[rolanni.livejournal.com]

Yeah, when my thyroid first went wonky, the received wisdom was that "women of a certain age" were just naturally going to feel tired. I was writing Crystal Dragon at the time, and this is how I was writing -- three words, nod off, catch self before head hit keyboard; type three words; nod off, catch self before head hit keyboard; lather-rinse-repeat.

So, I called the doctor and said, "If this is what the rest of my life is going to be, shoot me now." And she said, "Maybe we should check your thyroid."

The last half of Alliance of Equals was also written in the type, nod off, snatch awake method, which is why we're back to tweaking the dosage.

I read something. . .a long time ago that it wasn't that the active ingredients were different, it was the different fillers used that caused the different effects in absorption.

Well. An adventure.

Generics and formulary

[elgordo303.livejournal.com]

There are basically 2 kind of generic drugs . Class A in which the active ingredient is the same as the name brand and class B in which the active ingredient is different but has the same biological effect as the ingredient in the brand name. The active ingredient in Synthroid is the same as levothyroxine.

A 'drug formulary' is just a list of drugs.. Formularies are created by pharmacy benefit management(PBMs) providers. These PBMs are middlemen between your insurance provider and the pharmacies and pharmaceutical companies. Their function is to minimise the drug costs to the health care provider.

Formularies are created based on the PBMs ability to leverage their purchasing power to force the pharmaceutical companies to give them the best prices on drugs.,.. One of the tools they use is formularies specifically crafted to maximuze the use of a particular manufacturers products so that the manufacturers get to sell more of there products in exchange for lower prices on specific drugs.

The demonization of brand name drugs is a nothing more than a sales tactic to reduce opposition to generics.... This tactic is used to counter the advertising that brand name drugs benefit from in the minds of consumers.

15 years in the PBM industry ...if there's a hell.,. I've earned a special place there.

Re: Generics and formulary

[rolanni.livejournal.com]

That not only sounds like a nightmare, but it's SUCH a waste of your time and energy. It's not like there's enough hours in the day without having to cope with insurance company nonsense, too.

I think, but cannot be certain, without going back to review my notes, that the T4 situation is "within parameters", but the T3 was a problem. The last whole panel blood test caught the fact that the pituitary gland is pumping out 'way more hormone than it should, in order to achieve those thyroid numbers, so we're now in the process of fiddling the dosage, to find the sweet spot. In in the midst of which comes the drug changeover.

It's minor in the Big Worldview, but I'm kinda getting tired of vampyres.

Re: Generics and formulary

[rolanni.livejournal.com]

You kind of want to believe that the people who are in charge of making sure you receive good care actually care about your health. I realize that this is unutterably naive, and the insurance and prescription drugs and, hell, medical procedures are all Big Bidness, but it seems. . .obscene that there is no one in a position of power over you as you get older and need to rely more on the goodwill and care of others -- no one who who cares more about you than they care about a buck.

Sorry, Gord. Have you seen The Invincibles?

[thewol.livejournal.com]

You want Machiavellian Big Pharma machination$$$? I do much better on Armour Thyroid which is, according to Big Pharma and the health care insurers, nothing short of HERESY! Gospel says *Everyone* does better on synthetic thyroid hormone (which is straight T4) -- despite numerous medical studies that show that that about a fourth of the people who need thyroid hormone do best on a mixture of T3 and T4, such as Armour thyroid provides. What makes it Heresy is that there's more money for Big Pharma in synthetic hormone which they can make much more cheaply than it costs to purify it from "organic" (porcine) sources. I've been swimming upstream against that current for 20 years. Every time I change providers or insurance, I have to fight that fight all over again.

Big Pharma only has a certain number of years to recoup their new drug development, drug trials and FDA approval costs before other drug companies are allowed to release a generic. That's why new, brand name drugs cost so durn much. Once other companies are allowed to release generics, that tends to cut the amount they can charge for brand name down in order to keep competitive, although the price of brand names versus generics is still significantly higher, as Big Pharma gives doctors kickbacks for writing "brand name only " prescriptions -- again to charge as much as they can for as long as they can get away with. Synthroid has been on the market long enough that there's not that much difference between generic and brand name price any more.

As long as you are getting with your health care provider, if your T3 is low, you may benefit from Armour Thyroid -- even though what they look at for judging "normal" is your T4. T3 is a precursor of T4, and it stands to reason the more T3 you have available, the more T4 you can make.