Additionally, managed care organizations (MCOs, commonly known as insurance companies) do not pay for brand name medications just because a doctor prescribes them. If the MCO is aware of a generic option, then they will only pay for the generic or they will ask the doctor for a "prior authorization" to justify the use of a brand name medicine (such as the generic version not working).
The pediatricians I have visited in recent years even have the MCOs' formulary available for the patient in their systems, so they can see which medicines need a prior authorization and which do not so there is no time wasted on figuring out what the MCO will pay for without prior authorizations.
This is so obnoxiously common across every profession.
People are willing to piss away other people's money on "the best" without even telling them what the options are.
Every time I try to wrap my head around this stuff. How to fix the problems with our current system. I keep coming back to socialized or single payer health care.
Sure the current system works okayish for people like me. Insured and employed. But for my friends and the people I meet on the streets or the grocery store it's a nightmare. There is real suffering and death caused by no access to adequate health care. Even basic preventative stuff like diabetes care and checkups is missing.
https://khn.org/news/you-can-buy-insulin-without-a-prescript...
It's changed a lot recently as doctors have become more aware of the cost of these drugs. But you still have to self advocate for less expensive drugs. Less savvy people often have trouble getting transparency into drug costs. Often even the doctors can't get a straight answer on pricing and insurance coverage.