A physician colleague's insurance will not cover her anti-nausea medicine (Zofran/ondansetron) for her CHEMO. It is $280.40 cash for 30 pills at Walgreen's. I logged into a physician/hospital medical supply company and can buy 30 pills for $3.30. That's an 8500% markup. 1/

It is easy to be angry at the insurance company bc Zofran is a well-known therapy for chemo-induced nausea and it should absolutely be covered. However, I'm sure Walgreen's buys in bulk and gets it for even less than $3.30. Add in labor, plastic bottle and charge $25. 2/
Retail pharmacies make an absolute killing, especially on cash-pay patients. Some pharmacies will offer a cash discount. However, in some states, pharmacists are not allowed to tell patients if the cash price is lower than their insurance co-pay. This is absolutely criminal. 3/
Medicaid negotiates with drug companies. For example, if you had asthma prior to 2016, Medicaid would cover brand-name Xopenex inhalers but not generic albuterol. So, we would have to write prescriptions for an expensive drug the patient didn't need so it would be free. 4/
How are emergency room physicians supposed to remember what drugs are on Medicaid's formulary, let alone all of private insurance? But how frustrating to be a patient and take in a prescription your doctor thinks you need only to find out it isn't affordable. 5/
Emergency physicians are shift workers. Then the pharmacy calls and asks for the doc who wrote the Rx to see if they can substitute something else. But that doc is home sleeping to return in 12 hr and the new doc is busy seeing her own pts, plus she doesn't want the liability. 6/
The patient is angry, the doctor is frustrated, and the pharmacist is busy because there's a line out the door and the doctor is in on a code blue so he's on hold. All of this could be avoided if prescription drugs were covered equally by all insurance. 7/
So, realize when you see an ER physician "on the phone," we jump through a ton of unnecessary hoops trying to do the right thing. There is much wasted time on red tape that cannot be done by the clerk. And we worry you won't ever get your prescription filled at all. 8/
Because if you don't, and your infection gets worse, we know you'll be back and then we've just doubled our work. You'll probably be sick enough for admission but there aren't any beds. 9/
So you'll wait in the ER and we'll avoid eye contact the 9 hrs you're there feeling like we've failed you. But you belong to the upstairs team now. And we did everything we could. How could we have known? A $20,000 hospital stay bc your $10 antibiotic was priced at $300. /End
Also realize that we are not supposed to know what kind of insurance you have or if you even have insurance. And it feels kinda unethical to ask because we treat everyone in the ER. It's not easily accessible in your chart. However, the most worthless Rx is the one never filled.

More from Health

this simple, counter narrative fact keeps cropping up all over the world.

hospital and ICU utilization has been and remains low this year.

it's terribly curious that so few of these monitoring tools provide historical baselines.

getting them is like pulling teeth.


we might think of this as an oversight until you see stuff like this:

this woman was arrested for filming and sharing the fact that their are empty hospitals in the UK.

that's full blown soviet. what possible honest purpose does that

this is the action of a police state and a propaganda ministry, not a well intentioned government and a public heath agency.

"we cannot let people see the truth for fear they might base their actions on real facts" is not much of a mantra for just governance.


90% full ICU sounds scary until you realize that 90-100% full is normal in flu season.

staffed ICU beds are expensive to leave empty. it's like flying with 15% of the plane empty. hospitals don't do that.

and all US hospitals are mandated to be able to flex to 120% ICU.

the US is currently at historically low ICU utilization for this time of year.

61% is "you're all going to go out of business" territory as is 66% full hospital use.

can you blame them for mining CARES act money? they'll die without it.
You gotta think about this one carefully!

Imagine you go to the doctor and get tested for a rare disease (only 1 in 10,000 people get it.)

The test is 99% effective in detecting both sick and healthy people.

Your test comes back positive.

Are you really sick? Explain below 👇

The most complete answer from every reply so far is from Dr. Lena. Thanks for taking the time and going through


You can get the answer using Bayes' theorem, but let's try to come up with it in a different —maybe more intuitive— way.

👇


Here is what we know:

- Out of 10,000 people, 1 is sick
- Out of 100 sick people, 99 test positive
- Out of 100 healthy people, 99 test negative

Assuming 1 million people take the test (including you):

- 100 of them are sick
- 999,900 of them are healthy

👇

Let's now test both groups, starting with the 100 people sick:

▫️ 99 of them will be diagnosed (correctly) as sick (99%)

▫️ 1 of them is going to be diagnosed (incorrectly) as healthy (1%)

👇

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