Standing Taller


“$380 for nine pills a month is outrageous, Doc!” He was almost shouting into the phone. I held the receiver away from my ear. He had just finished telling my medical assistant that I was lazy. 

“I agree completely, sir.” I took a deep breath and launched into my spiel.

I told him that he needed to check with his insurance company to find out if one of the other erectile dysfunction meds was cheaper. I already knew the answer was no. I had been through this dozens of times with other patients. In fact I had told him this before, several times. Still, he was not going to believe it until he heard it from the horse’s mouth, otherwise in his mind I was just not trying hard enough. 

“I know I am not the only person with insurance from this company in your practice,” he accused.

“You are right. But each major insurance company has dozens of sub policies negotiated by employers. There is no possible way I can know and keep track of them all particularly when they change each year.” 

“I’ll just find myself another doctor…”

What did he want me to say? 

No wait! Don’t go! Please keep verbally abusing my staff for something beyond our control.

I could not blame him for acting like a prick. I understand his frustration, even if it was misdirected. The pharmaceutical companies and the insurance industry were holding his sex life for ransom and it was NOT fair. He was a young man. He had a relationship. He had every right to be angry.

Viagra was first approved by the FDA in 1998 and it is under patent in the US until 2020. There may be a generic available in the US in 2017 but that has been changed before by legal wrangling so I am not holding my breath. Incidentally the generic has been available in dozens of other countries for years.  This fact has caused the price of Viagra to increase streadily to an average of $35-40 per pill in the US, a cost that is not covered by most insurance policies. 

Meanwhile, in the UK a pack of four generic sildenafil costs ÂŖ1.45, about $2.26…. 


103 thoughts on “Standing Taller

  1. Single payer system is the only answer. And negotiated prices for everyone.

    Many insurance companies are now charging bizzare co-pays for injectable drugs — 50%! That includes not only the $$$$ biologics but insulin, etc.

    I hate insurance companies. (I know it’s not only them. I’ve worked for both the insurance and pharmaceutical industries. I pick Pharma over Insurance in terms of integrity any day of the week.)

    Liked by 4 people

      • Drug companies make things that help people. That’s the whole point.

        More and more I feel like insurance companies are in business to screw people, to get every last nickle out of each and every one of us.

        I’ve worked with some of the smartest people in the world — my current boss and the folks at WHO. My years at Harvard Law School. Working for former Cabinet Secretaries. And none of them have asked to or expected to be treated with the deference of the Insurance Company executives. They were revolting. No doubt, they still are.

        Liked by 4 people

  2. “I could not blame him for acting like a prick” Hee! Rather apropos in this case. But…drug prices ARE outrageous in so many instances yet consumers will pay for them because they don’t know any better; they won’t/can’t fight for reform; they are overwhelmed with health issues in general, and OUR SYSTEM SUCKS.

    Liked by 4 people

    • I had a patient the other day pay the cost out of pocket for ten pills only to find after the first couple of pills that he gets terrible headaches with it and cannot use them. It is not like he can take them back for a refund.


  3. How uncanny that I have just published a post on the cost of basic painkillers here in the UK!
    Prescription drugs are ÂŖ8.20 an item. This can work out expensive if you need more than one item and the GP insists on only prescribing one month at a time whereas some will issue sufficient for three months. However, for a set amount, you can buy a year’s ‘ticket’ which covers any prescription for any medication required.

    Liked by 1 person

  4. To be clear, that cost in the UK is the cost to the National Health Service. The individual would pay ÂŖ8.20 per prescription. If they’re over 60, or out of work, or on very low income, they wouldn’t pay a penny… Very different systems!

    Liked by 1 person

  5. The differences in our systems are amazing. (For the most part, I think American health care stinks.)

    When I was working in the NHS, we had a big push at the time to persuade GPs to prescribe generically, at least giving them more budgetary control soon wished them up to the sense of that.

    Viagra is quite pricey here on the black market in Gib. Say around ÂŖ10 or so per tablet.

    Liked by 1 person

      • In the UK, people ie the public, are uneducated re generics. I had a silly discussion with a former friend about some cold sore cream, Zovirax. I went to the pharmacist and she offered me the shop brand generic. I asked to look at the two to compare, and, as she said, the active ingredient was the same. So clearly I bought the generic.

        Stupid, stupid ‘friend’ insisted they were different. How do you argue with that? I tend to use vodka for most things oral though. The point is though that people (in the UK) aren’t aware of the difference between active ingredients and brand names.

        And when Viagra first came into the UK, no one at work referred to it as that, it was always sildenafil.

        I can understand the need to recover R&D costs and have a short-term patent. But not profit in perpetuity.

        Liked by 1 person

  6. OMG! That whole subject is maze Victo, created by pharma and insurance and gov’t regs. We actually studied that in B-school. It is Byzantine from any perspective. Even worse than that are the rules around the sales of patented medications in third world countries. The UN, along with the drug patent holders have agreed in principle to allow the production and distribution of life saving drugs charging only the manufacturing costs and not the patent costs. That said, not only do they fight over this but many countries won’t .produce the drugs or allow them to be distributed. There is a classic business case study of Merck and their cure for River Blindness – published under: STEPHANIE. WEISS. AND. DAVID. BOLLIER: Having the Vision to Succeed. Merck accidentally discovered a cure for this terrible disease and would not produce it because they could not get their money back – the 18 million afflicted were too poor.. One of the executive – Dr. P. Roy Vagelos – deliberately lied to the board and used close to $1 billion without permission to produce the drug before he was caught and fired.\WHO refused to distribute saying it was the responsibility of the countries involved. The countries involved were suspicious and refused to allow distribution. Eventually Vagelos convinced Medcins sans Frontiers to sneak the meds into the villages where they were needed. The treatment was only two pills requiring no special handling and resulting in a life time cure of the disease and stopping any further development in those who were already infected. It was one of those modern medical miracles – it totally stopped the disease forever.

    In the end the press got hold of this and made a hero of Vagelos; the local gov’ts had a statue of him commissioned; and Merck hired him back and told everyone that was the plan all along. Ha! Merck stock shot up in value and the board all patted themselves on the back.

    This subject is surreal Victo and the more you study it the more you can’t believe what pharma, the insurance companies and the governments are doing with drug pricing. And the worst of it is that every time someone with authority calls for an investigation into pricing – the drug companies say ” No problem we’ll move our billions in R&D and production to another country and you’ll lose the jobs and maybe even the medications” And that is the end of it.. 😀

    Liked by 4 people

  7. It is a horrible situation. There are many meds like this as far a price goes. I’ve heard horror stories about the meds used by cancer patients. It’s getting to the point where it’s your money or your life. There is a point where the quality of life comes into play. If I have to live in abject poverty to pay for meds, maybe I just won’t.

    Liked by 2 people

    • People have the belief that physicians hold much more power and sway than we do in actuality.
      What power we did have has been whittled away. I cannot force his insurance company to approve something they don’t cover at all. Frustrating for everyone all around, really.

      Liked by 1 person

  8. It drives me crazy that they spent the time and money and now charge and arm and a leg…or dick for a man to get laid… I could go on a rant, but I won’t. Instead let’s talk about how they still cannot find cures for things that kill children, that they cannot even get medicines to make them have something of a life. My nephew in law works for a pharmaceutical, and I hear of the misuse of funds and I get sick.
    Speaking of: my old shot (Enbrel) for my psoriatic arthritis cost almost $800.00 a week. It stopped working. The one I am now cost $1800.00 a month and it is not working well either. And it is not about getting laid; its about being able to walk or hold a pen or sleep for more than four pain free hours.

    Liked by 1 person

  9. On the whole, “I’ll just find a new doctor” threat, I have to say that we have gotten so costumer service-oriented that patients have come to expect that we can and should be able to resolve their every request. I have had three different patients become angry with me this week because I can not give them the exact day/time slot they want for their speech therapy appointment. One gentleman, a chronic aspirator who gets repeated bouts of pneumonia, said he couldn’t come to his speech therapy for dysphagia before 2 pm because he has billiards with his friends until that time of day. (He also doesn’t want to come later than 3 because it leaves him with an awkward break between pool and dysphagia treatment.)

    Liked by 1 person

    • Ah, yes. We get that, too! I wonder if they really actually want to see a doctor that has last minute time slots available at all times. That would imply an empty schedule and that would make me wonder about the quality of care…

      Liked by 1 person

  10. He “acting like a prick”, splitting the pills to “get more bang for your buck”…You’re on a roll, Doc. â˜ē
    All the tv ads for those pills, with couples sitting in outdoor side-by-side bathtubs, who knew those puppies were so expensive !

    Liked by 1 person

  11. I can tell you as an 20 year health care/insurance company employee that it is TOTALLY about screwing over anyone who gets in the way of the balance sheet. And as a mother of a son with Post TBI that left him with epilepsy I have no love for the pharmaceutical companies either.

    Liked by 1 person

  12. Yesterday I had someone pay $814 for cialis…. He didn’t even flinch, it’s sad we have got to that point. Meanwhile on Medicaid its $1 and probably just being sold on the black market…..

    Liked by 1 person

  13. UGH!!!! Outpatient medicine is so frustrating. I love how insurance companies get to dictate how we practice. I sometimes think we should just let them provide the care.
    On another note: Your lamp post pic makes me want to post one of mine… (I may only have 1…. ) But, still.

    Liked by 1 person

  14. It will get worse unless he has a good contact. In the Netherland millions of citizens are obliged by law to have a basic health insurance. The government and health insurance companies corner the market. The manufacturers and laboratories corner the government and the health insurance companies. Who pays for everything in the end? Citizens treated like consumers, ATMs made out of flesh and blood.

    For the past years Dutch health insurance packages (“polis” in Dutch) have increased in price and decreased in services and the only way to keep costs down is to have a higher personal-risk limit (“eigen risico” in Dutch) and not get ill or injured.

    When things go wrong, the citizens who are consumers and patients have to wait and pay. Medical professionals are forced to follow orders and the politicians and company executives responsible can get away with almost everything. Healthcare insurance is a good thing. The implementation is the issue…

    Liked by 1 person

  15. Very interesting information, Victo. I have my own drug-pricing bone to pick about colchicine (now, effing “Colcrys”, in the U.S.). So much horsesh#t, all a meal we are forced to swallow with each overpriced pill.

    Liked by 1 person

      • I take it for Behcet’s. Uninsured for two-plus years–’09-10–I paid over $300/mo. for my mere 60 pllls of colchicine after Canada raised prices thanks to all the desperate ‘Murricans buying from them. I hope there’s a special circle of hell for every drug co. and FDA employee involved in these types of blatant money-grabs.

        Liked by 1 person

  16. Pingback: Sexless?? | Looking for Chris

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