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Jay Lake
Date: 2013-01-16 05:42
Subject: [culture] Pharmaceutical Puritans
Security: Public
Tags:cancer, health, personal, sex
My insurance plan, like many, has multiple tiers of pharmaceutical co-payments. Most of my drugs cost me $10 per prescription filled or refilled. A few cost me $20. Exactly two cost me $50. Those same two drugs are also the only drugs I have ever been prescribed in my life for which my insurance company limits the number of doses I'm allowed per month below what the doctor prescribed.

That would be Viagra and Levitra.

Ever since my colon surgery in May of 2008, I have had persistent erectile dysfunction. The probable root cause is surgical disruption to the vagus nerve. That, and the effect of being in my later 40s with a lot of medical and life stress, has kept me from ever recovering full functionality.

If and when any organ in my body other than my penis malfunctions, insurance covers everything required. I have co-pays and other minor hassles, but my insurance carrier is consistent and supportive. They have unquestioningly paid for drugs that cost $10,000 per dose, as needed in my chemotherapy regimen, with no co-pay at all because they were dispensed in a clinic.

But when I need a drug to help me enjoy the basics of male sexuality, I'm limited to a handful (or less) of pills per month and charged 2.5 to 5 times what every other drug I've ever taken costs me, when I have had a co-pay at all.

Is there any logical reason for this? To my view, this is just the ingrained Puritanism in American culture. Yet another stupid price we pay for the Calvinism in our national DNA. The unwillingness of many people, most of them conservatives, to contribute to the sexual enjoyment of others. Millions for cancer, barely a few cents for a good fuck. I cannot imagine any medical or financial justification for this beyond simple, petty discomfort with human sexuality.

I know perfectly well the sordid history of health insurance and female birth control. I don't expect much sympathy from female readers, who have borne the full cost of their sexual health for decades, until quite recently. But it's really the same problem that conservatives so ardently and wrongly tried to smear Sandra Fluke with: people don't want to think they are paying for other people to have sex.

You know what? I'm just as entitled to sexual health and well being as I am to any other form of health and well being. This is really a minor issue in the symphony of horror which is my cancer experience, but it's a damned annoying one. The medication restrictions on sexually related drugs are just petty, and serve no purpose other than to make some people, somewhere, feel good about punishing me for having a libido and opportunities to exercise it.

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Lisa Costello
User: radiantlisa
Date: 2013-01-16 13:51 (UTC)
Subject: (no subject)
Fuck cancer?
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rekre8
User: rekre8
Date: 2013-01-16 18:34 (UTC)
Subject: (no subject)
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jordan179
User: jordan179
Date: 2013-01-16 14:12 (UTC)
Subject: (no subject)
I feel for you: I have the same problem and they don't work for me.

As for Sandra Fluke, I don't know about other conservatives but what bothered me was that she expected other people to pay for her contraceptives, and contraceptives are dirt-cheap. And she was costing them on the basis of using them once per day, which is a rather ridiculous expectation for college unless she was engaging in an, ahem, alternative means of funding her education. And in that case, she would have no difficulty paying for the contraceptives!
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Jay Lake
User: jaylake
Date: 2013-01-16 14:59 (UTC)
Subject: (no subject)
hat bothered me was that she expected other people to pay for her contraceptives

That is the explicit conservative lie that has become so pervasive. What Sandra Fluke wanted was access to contraceptives through the health insurance plan for which she was paying premiums. Go look it up.
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Emperor of my private reality
User: eustaciavye
Date: 2013-01-16 15:05 (UTC)
Subject: (no subject)
oral contraceptives are a daily medication whether you are having sex once a month, once a year, or four times a day. You take the same number of pills - one per day. Period.
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Renee Babcock
User: renegade500
Date: 2013-01-16 15:48 (UTC)
Subject: (no subject)
I wish all conservatives would get the issue of hormonal birth control right.

Sandra Fluke never expected anyone to pay for her contraceptives. She was testifying on behalf of a friend who had a medical necessity for contraceptives and the friend's insurance company refused to cover the medication her friend needed, a medication that could prevent her friend from becoming infertile. The majority of women on hormornal BC are actually on it for medical reasons. That it prevents pregnancy is a secondary benefit.

The ruling from HHS said that *insurance companies* had to cover BC without a copay as part of the services women are already paying for in their premiums.

The HHS ruling was based on the recommendations of a panel of doctors. The panel of doctors made recommendations for both men and women to have preventive annual coverages at no additional cost outside the premiums being paid. Considering many women have not had any BC coverage, because of insurance companies discriminating against women, this was a huge issue, because no longer can insurance companies discriminate against women.

Now, let's address the other statement you made which is false, to wit, that contraceptives are "dirt cheap." We're not talking condoms here, we're talking hormonal birth control, "the pill" or BCP. To address your apparent ignorance on how BCP works, you do actually take one pill per day. It's not like viagra, where you take as needed. The idea of BCP is that it keeps your hormones at certain levels, and the only way to do that is to take one pill per day.

There is no single formulation of "the pill." There are hundreds of formulations, because no single formulation works for all women or their medical needs.

I did a survey of hormonal birth control available through drugstore.com last year.

Keep in mind pill packs come in 4 week (28 day) packages, so you're looking at 13 packs per year, not 12. Secondly, they're only available by prescription, which means a woman has to have access to a doctor, who will give her an annual exam and prescribe the pills. Most doctors require these exams yearly. Luckily, that's now a cost (if one has insurance) that is also required at no extra co-pay. But before that, as an example, I had to pay $30 a year. I think that's about average, so add that on to the cost. If you don't have insurance, that cost is much higher.

When looking last year at drugstore.com, there were 72 formulations available in 28 day packs (to keep an apples to apples comparison). Of those, the average retail cost (i.e., the cost a woman without insurance has to pay) was $56/28 day supply. A yearly supply would be $728 (56*13, since 28*13=364 days). The lowest price formulation I saw was $28/28 days, the highest price was $96/28 day supply. There wasn't a single formulation with a *retail* price of $10/28 day supply, which I would say is cheap.

Of those 72 formulations, 19 of them, or 26%, had a cost of $76/28 day supply or higher. At $76, a yearly cost would be $988; at the upper end of $96, yearly supply would be $1,248. This is not dirt cheap by any standard.

Keep in mind this cost was being born by large numbers of women because their insurance companies were refusing to cover hormonal birth control, a medication most women had a medical need for, thus requiring women to pay these costs out of pocket. With the HHS requirements, insurance companies will be required to cover hormonal birth control and at no additional copay cost to the patient, as part of the services already covered under their premiums.

See, you aren't being asked to pay for my birth control, or anyone else's for that matter. But thanks for playing along with the Sandra Fluke is a Slut game.
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Tom
User: voidampersand
Date: 2013-01-16 16:37 (UTC)
Subject: (no subject)
This is good information. If I understand it correctly, a woman doesn't get to choose a formulation based on price. She is prescribed a formulation and then she has to pay whatever it costs. Some of them are just more expensive than others.
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Renee Babcock
User: renegade500
Date: 2013-01-16 16:49 (UTC)
Subject: (no subject)
Exactly, because her doctor will know which is the most appropriate formulation based on the chemical makeup of that formulation and the woman's particular medical needs. Hopefully what a doctor prescribes will be on a given Rx formulary, but if not, SOL. And of course, some formulas not available in generic form, which of course makes them more expensive (and insurance companies less likely to want to cover them).

I'm fortunate in that I work for a large state university, so my employer (which insures around 100,000 people statewide) is able to call a lot of shots when negotiating insurance contracts, and has always covered BCPs. We also have the option to get maintenance medications in 3 month packets at a significant cost reduction.

Luckily for me, what I'm taking has a generic, so my cost before the HHS ruling was relatively low. But if my doctor had felt I needed something more expensive, my choices would have been pay up or go without (in my case, not an option due to medical necessity). And I'm one of the very lucky people with excellent insurance that covered BCPs.

It just really pisses me off when I see people saying women can walk into Walmart and get pills for $4/month, when it's obvious by that statement they don't really have a clue how inaccurate that statement is. Sure, some women can, but most cannot. (Of course, some of these same people also thought women could walk into any Walgreens and just get a pap smear.)
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mmegaera
User: mmegaera
Date: 2013-01-16 23:11 (UTC)
Subject: (no subject)
And sometimes the generic isn't a good idea even when it's available. The generic of the pill I took for years made me sick to my stomach. The proprietary one didn't.
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Jay Lake
User: jaylake
Date: 2013-01-16 15:54 (UTC)
Subject: (no subject)
For that matter, setting all the other issues aside, what's wrong with paying for contraception?

Reduced access to contraception leads to higher abortion rates, so pro-lifers ought to be all over providing contraception as widely as possible.

Increased access to contraception leads to a wider range of economic and lifestyle choices for wowen, so pro-choicers *are* all over providing contraception as widely as possible.

From a purely resource management point of view, pregnancies, wanted or unwanted, are far more expensive than contraception, so anyone interested in managing healthcare costs ought to be all over providing contraception as widely as possible.

Is there any policy, social, financial or medical reason *not* to support what you are erroneously calling free contraception?

Edited at 2013-01-16 03:55 pm (UTC)
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mmegaera
User: mmegaera
Date: 2013-01-16 23:12 (UTC)
Subject: (no subject)
Right up there with why businesses should be all over single-payer health care, isn't it?
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cathshaffer
User: cathshaffer
Date: 2013-01-16 16:10 (UTC)
Subject: (no subject)
Aside from the factual issues addressed elsewhere, what is ridiculous about having sex every day?
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Jay Lake: graffiti-cheetohs
User: jaylake
Date: 2013-01-16 16:11 (UTC)
Subject: (no subject)
Keyword:graffiti-cheetohs
This.
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Msconduct
User: msconduct
Date: 2013-01-17 01:29 (UTC)
Subject: (no subject)
Yes. And not only is it not ridiculous, it doesn't imply that you must be a prostitute either. It seems amazing that this must be said, but apparently it must.
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cathshaffer
User: cathshaffer
Date: 2013-01-17 03:20 (UTC)
Subject: (no subject)
Not necessarily relevant, but there is a persistent strain of belief among Christian evangelicals that a wife should be servicing her husband every day, even if she's indisposed, even if she doesn't feel like it. There are even sex toy stores for Christians, so that a wife can do her godly duty by "gifting her husband with an orgasm," and I've seen 30-day sex challenges on Christian blogs, so it seems like this attack on frequent sex is extremely context specific. Those who have arrangements we approve of have permission to have sex every day (especially if the woman is a martyr providing a service she is not actually enjoying), but those who don't have such arrangements are prostitutes. Nice.
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Msconduct
User: msconduct
Date: 2013-01-17 04:33 (UTC)
Subject: (no subject)
Urgh. Appalling!
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mcjulie
User: mcjulie
Date: 2013-01-16 16:19 (UTC)
Subject: (no subject)
Your statement appears to reveal that you listen to Rush Limbaugh, since he is the primary source of both these falsehoods -- that she "expected other people to pay for her contraceptives" and the misrepresentation of how hormonal contraceptives work. (Which is really quite a shocking bit of ignorance in this day and age.)

Listening to Mr. Limbaugh is probably not a good idea.
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Jay Lake
User: jaylake
Date: 2013-01-16 16:22 (UTC)
Subject: (no subject)
Listening to Mr. Limbaugh is probably not a good idea.

Not if you expect accurate or factual information about pretty much any topic, no, it's not a good idea. Likewise FOX 'News'.
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russ: quo vadis
User: goulo
Date: 2013-01-17 22:51 (UTC)
Subject: (no subject)
Keyword:quo vadis
> And she was costing them on the basis of using them once per day,

Are you really that unaware of how birth control pills work?

Have you really never seen the little boxes they come in with a pill for each day with a day or date next to each pill?

They are prescribed to be taken every day because that's how they work.

They're not like a condom that you put on only when you have intercourse.

Why are so many conservative men so ignorant of such basic facts about women's health and contraception, yet feel qualified to tell women how to deal with their own health and contraception?
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MG Ellington
User: xjenavivex
Date: 2013-01-16 14:37 (UTC)
Subject: (no subject)
The availablity of that medicine at an affordable cost is important to this female reader. It directly effects my husband, but it effects us both really.
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fledgist
User: fledgist
Date: 2013-01-16 14:43 (UTC)
Subject: (no subject)
It brings your husband into existence?

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fledgist
User: fledgist
Date: 2013-01-16 14:43 (UTC)
Subject: (no subject)
Sex is considered an optional extra, not a necessary part of the good life. There's something wrong with that.
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Emperor of my private reality
User: eustaciavye
Date: 2013-01-16 15:10 (UTC)
Subject: (no subject)
As a female reader who very much enjoys her free birth control from the affordable care act and who is also a Health Care Professional (insert theme music)... I also think that someone who has ED, particularly as a direct result of a medical crisis such as cancer, should have access to the appropriate medication for daily use. What angered me was when insurance plans that WERE covering Viagra (at the time brand name and $10 a pill) were not covering even generic birth control pills ($10-15 a month). Either cover them both and admit that sex matters to everyone, or refuse to cover either and admit you hate sex.

Some cases of ED are psychological and not physical and if that's the case, there's other solutions besides meds, but then again therapy isn't free for the insurer either. Either way the insurance should pay for the appropriate treatment.
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barbarienne
User: barbarienne
Date: 2013-01-16 16:29 (UTC)
Subject: (no subject)
I guess the theory is that being celibate technically won't kill you.

Maybe our health care industry needs to consider that "quality of life" is a reasonable thing to provide as well. They try very hard to avoid that in as many circumstances as possible (not just sex).

And while "gets to have an erection" may or may not be considered necessary for a quality of life, there is often another person(s) involved, and that relationship almost certainly is necessary to the ailing person's quality of life and psychological well-being, and their continued presence can improve the ailing person's outcome significantly.

Sigh. So few people understand long-term effects and benefits.
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dionysus1999
User: dionysus1999
Date: 2013-01-16 17:53 (UTC)
Subject: (no subject)
Sexual health therapy is frequently not covered by insurances either, not "medically necessary".
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Emperor of my private reality
User: eustaciavye
Date: 2013-01-16 22:01 (UTC)
Subject: (no subject)
That's interesting to me because I am a therapist who does couples counseling and a lot of my couples use their insurance to pay for it. Most insurance cover couples counseling in fact. I wonder if the insurance people realize we are FREQUENTLY talking about sexual issues in those sessions.

Maybe I should keep quiet so they don't yank that benefit too.
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dionysus1999
User: dionysus1999
Date: 2013-01-17 13:25 (UTC)
Subject: (no subject)
I think diagnosis is what they look for, Blue Cross does not cover marital therapy, for instance, but if you call it something else they don't seem to mind. We know if the diagnosis has the word "sex" in it, they will reject it.

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Autopope
User: autopope
Date: 2013-01-17 01:42 (UTC)
Subject: (no subject)
This is not unique to the US health insurance industry.

Here in Scotland[*], drugs for erectile dysfunction are only available with NHS funding for a very limited number of conditions, most of them involving severe post-surgical damage. Got ED because of a minor adverse drug reaction for something like hypertension? You'll have to pay for a private prescription.

The ostensible justification is that Viagra, Cialis, etc are horrendously expensive and We Can't Afford It. The truth is, they're not that expensive compared to various chemotherapy or other treatments that are nodded through on the public purse -- it's just terror of the media backlash if they allowed them to be provided free at the point of delivery like other medical services.



[*] I'm in Detroit right now, but I live in Scotland
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Steve Green: Outlaws
User: stevegreen
Date: 2013-01-17 03:08 (UTC)
Subject: (no subject)
Keyword:Outlaws
Ann used to complain that tampons attract Value Added Tax, as though they were a luxury item rather than a necessity.
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seventorches
User: seventorches
Date: 2013-01-17 04:46 (UTC)
Subject: (no subject)
On a related note, Food stamps (SNAP or whatever they're called now) won't pay for any feminine supplies,

Do Maxi-pads attract the VAT? Because if not, then at least they can make the argument that Tampons have the luxury of convenience, small size, comfort, etc. vs basically wearing a thong diaper.
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Button: button in scotland
User: supersniffles
Date: 2013-01-17 08:36 (UTC)
Subject: (no subject)
Keyword:button in scotland
I understand your pain. My anti-depressants caused me to lose the ability to orgasm for several months. In my normal life, I soothe myself to sleep nearly nightly by self pleasuring. Having that suddenly taken away did not significantly lessen my depression. My doctor prescribed an ED pill, (There hasn't been a lot of research, but there is some evidence that increasing the blood flow to the area helps both sexes 'achieve'.) He gave me some samples and my 'completion' rate went from about 5% to about 60%. And then the samples ran out, and my insurance company will *NOT* cover them, because I don't have a penis. They cost $32 a pill. $16 if I was able to get there on a half pill!
(Luckily for me, I did eventually find a solution. After taking the pills for a few months, I found a 2-3 hour window, as yesterday's pill was wearing off and before today's pill kicked in, where I could come.)
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Amanda
User: cissa
Date: 2013-01-18 05:29 (UTC)
Subject: (no subject)
Viagra et al. are covered far more than contraceptives and medical abortions. Even if you do not get as many pills as you would like- you are still getting more support than women are for your sex life as compared to hers.

Yes, that sucks all around.
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Jay Lake
User: jaylake
Date: 2013-01-18 13:44 (UTC)
Subject: (no subject)
Aren't female contraceptives now covered under the ACA? As I mentioned in the post itself, I'm familiar with the sordid pre-ACA record of coverage in that regard.
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