To Generic Drug or Not?

Working for a healthcare company can by incredibly interesting. There are more moving pieces than many people see and the government, federal and state, is always changing the rules. It means that nothing is set in stone. One aspect I don't like about the industry and company in particular is that I'm blamed, in a sense, for all the decisions the industry/company makes. Not to mention, people, my family included, feel the need to tell me their thoughts and feelings regarding the company's decisions. Most of those decisions are out of my control.

My dad, who has recently moved to Colorado and can't seem to pick up the phone to say 'hi'
(that's a different post), sent me a text today about the fact that he dislikes that my company is now requiring him to be on the generic drug for Lipitor as opposed to the brand drug. Furthermore, he felt the need to follow up my return text with an email stating that his insurance company should not be the one making his healthcare decisions.

I get it. Healthcare is an emotional and personal part of life. It is very hard to separate that feeling from any decision that is made, especially one that was seemingly made without you. In addition, many people outside the healthcare insurance industry simply think decisions are financially driven (which dad did point out). While I'm not going to tell you that decisions are not made with some financial incentive, I do want to point out some facts.

1. Healthcare costs in the United States have been rising and rising and rising
2. Generic drugs, while not identical, are bioequivalent to the brand
3. Many people have taken generic drugs with no complications
4. A generic drug is typically a fraction of the cost of a brand drug to both the individual and the insurance company
5. The decisions, while made in light of financial incentives, are not always for pure profit

So why does this matter? Lipitor, arguably one of the best blockbuster drugs of the 20th century, went generic in Nov 2011. My company made a decision, which I can say included medical expertise, to require members of fully insured plans to take the generic instead of the brand as of Jan 1, 2012. The decision, while saving money, is a way to push the common person to use generic drugs. Most generic drugs affect people the same way the brand does. And should a person find that they respond differently or adversely to a generic, healthcare companies are apt to make exceptions for people to use brands or another alternative. This is often known as step-therapy. They try to find the cheapest alternative that will get the job done. I recognize that that might not sit well with a consumer, but here's another side.

First a little insurance 101. Health insurance is supposed to be a means of spreading the risk of a catastrophic case over a number of people instead of having to bear the risk solely, much like car insurance. However, in contrast to car insurance, Health insurance has become a full maintenance plan where the average American believes a company should cover everything. The problem is, someone has to pay for the services. Generally, everyone pays a premium (often covered in part by an employer). As healthcare costs rise, the premium rises. The premium is set mostly to pay medical/ pharmacy costs. It is possible that if you are a healthy individual, you do not use your "fair share" of the medical costs. Contrarily, someone who has a heart ache or surgical complications may rack up hundreds of thousands or millions of dollars in medical bills. With the appropriate insurance, the bulk of those costs are covered and subsequently, an individual has a slightly more affordable bill (I do recognize there are varied circumstances and I am generalizing a lot.)

Back to Lipitor. Lipitor is a top 10 drug, which means, if you were to look at spend for the top 10 drugs per year, Lipitor would sit in that category, comfortably. Lipitor's sales were roughly $7.8 billion last year in the US (http://blogs.wsj.com/health/2011/12/08/how-much-money-will-generic-lipitor-save/). Now that Lipitor is generic, as much as $4.5 billion annually can be saved by 2014. This savings is transitioned into premium pricing for health plans around the country. Should people not actually switch to the generic, the assumed savings basically becomes an underpricing of a health plan. Consequently, in the subsequent year, this premium discount may be repriced to better reflect the actions of the population. Much like any business, an insurance company wants to make money. Though the profit margin baked into group premiums is not nearly as much as people think. After broker commissions, sales commissions, administrative costs, and medical costs, the profit is typically 2%. That money is often reinvested into the business to make IT improvements and acquisitions among other things. Fact is, there are many moving pieces and while some hit home harder than others, we're all trying to balance cost and reward. Healthcare is personal and don't think that we or anyone else making decisions doesn't realize that.

Great Things About 2011

While it's cliche, the end of the year is always a great time to reflect. It helps put the next year or the one after into perspective. The couple of years, I've completed a year in review. It's fun to remember all the great experiences I have had and know that even better ones are on the horizon. Here are the Great Things About 2011:

1. July 16 - Darden friends in town, engaged to my best friend and a fabulous engagement/birthday celebration to cap off the night
2. Derby 2011 (where my brother was engaged after the 6th race)
3. Great American Beer Festival (Why did I wait so long to go?)
4. Wedding dress shopping (Definitely found "the one")
5. Moving to Chicago
6. Charlottesville reunion weekend
7. April '11 - Cubs game followed by Uberstein and Art of Pizza
8. Monday nights at Tokyo sushi (I miss those!)
9. Vegas soccer tournament (still one of my favorite weekends every year)
10. Cooking Fools pasta making class
11. Q101 Jamboree Concert
12. Getting our Pottery Barn couch
13. Discovering Pilates
14. Humana Race to Taste (with an awesome race time!)
15. Brazil (Belo Horizonte, Iguassu Falls and Rio)
16. Sergio and Maria’s wedding in Brazil (absolutely amazing!!)
17. Volunteering for Boo-Palooza Wicker Park (little kids + Halloween costumes = adorable!!)
18. Brook’s 60th Birthday Bash in the Bahamas
19. Picking a caterer for our wedding (it’s going to be YUMMY!)
20. NYE 2012 @ Ana Mandara
21. Wedding Weekends: Christine and Scott, Sarah and Brian, Melisa and Chris, Madeha and Moshan, Angela and Nick
22. Brett goes skydiving!
23. Greenbrier (and shooting clays)
24. Mom’s successful Masquerade Ball in SF
25. Attending a show at Second City
26. Soccer!
27. IMAX: Transformers 3, followed by an amazing dinner at Japonais (all with great company)
28. Joe’s Seafood Engagement Celebration
29. Our engagement party

Office Cheer

It's a funny thing… office holiday cheer, also known as sweets, treats and sugar. Sometimes I think I would have a "healthier" day if I just worked from home. Early this week, I managed to spend an entire day walking by the cinnamon-sugar pound cake and didn't have even a bite. That said, it was half demolished by 11a. For the last three days, someone has so graciously brought in donuts. That's another treat that while they smell good, I feel horrible after eating them, like a rock just hit my abdomen.

We work in a cube environment and each cube has a bit of storage space with a flat top. You're not supposed to put anything on the top, however treats or other miscellaneous food items seem to be the exception to the rule. Maybe the thought is that these items won't be there long enough for anyone to be scolded. On one of the nearby storage tops was a set of brownies this morning. They looked homemade, so I asked who made them and took one as a morning snack (I was missing my 10a snack after all). I thanked the baker via IM and was promptly informed that she baked the brownies at 5:30a. WOW! Frankly, I'd rather be sleeping. To her, she was just spreading the holiday cheer.

While the office always seems to have goodies that magically appear, lately it has been far worse than normal. I can't quite figure out if people want to share the holiday spirit or if they feel less guilty when someone else indulges with them. Working in health has made me incredibly jaded about the decisions individuals consciously make. In a country that has an obesity rate around 30%, I shouldn't be surprised by all sugar filled snacks. I am one of those people with a bad sweet tooth. I just choose to indulge in moderation and hope that you think about doing the same the next time the office fills with free food. And if I don't indulge in moderation, I really should be running an extra couple miles at the gym. Maybe today is worth 3 mi. ;)

Thoughts on the End of a Chapter

I wrote this in October. It seems I never finished it or posted it.

Some moments, I breathe with ease. Other moments, I struggle to keep the wells at bay. It's hard to comprehend how we got here. Divorce. You would think at an age of understanding that this would be easier. I find myself over thinking the actions and reactions of the two "adults" that I call mom and dad. It is weird to think that now there may be a negotiation on where Christmas is held. Not to mention that while I myself am not married yet, I already feel like my family has doubled in size. And with that, so have the obligations. 

Dress Day

I walked into the store at 9a sharp, my mother by my side. Awaiting my arrival was my friend B and my future mother-in-law. I didn't know exactly what to expect. There were plenty of gowns and two trunk shows to boot. That day was to be the day I bought my wedding dress.

Our hostess showed us to a plush dressing room to drop our items. Then she and the four of us went to the main room where the Rivini Trunk show was setup. We started grabbing gowns. and moved from designer to designer until it was finally time to try on the gowns. The gowns varied from Cinderella fancy (and a hefty price tag) to sleek body hugging trumpet gowns. Of course, they all hug as most of them are made for people two sizes smaller than I am. I was just thankful that the gowns fit over my hips without having to go over the head.

I put on the first gown. I'm not sure exactly what I thought I would think or feel. I suppose the entire moment was anti-climactic. I looked in the mirror at a dress, that just happened to be white. And frankly, did not look very good on me. With that, the dress was off and we moved on. Towards the end of the first batch, we found a dress that everyone, including me, loved. From there, trying on dresses went into hyper speed and became much easier. Now we had a comparison. Was each subsequent dress better than "the one"? Turns out, 15 + dresses later, the answer was still no. We even ventured to the sister store, Vera Wang, where the second trunk show was being held. Pretty, but not "me". I'm not exactly sure with what I would have ended up if my friends and family hadn't been there. Mom was actually the one who picked out the gown for me.

After three hours at the bridal boutique, I walked out knowing which dress I will wear on my wedding day. I only have to wait 6 months until it is available for me to take home and alter. Afterwards, the ladies and I went to review bridesmaid dresses – LOVE LulaKate. We even decided on a slightly different color than what I had been thinking.

Very successful day! Another checkmark has been added to the list.

Open Enrollment

Whether or not you work there, they call it the pink palace. It's the company's corporate headquarters. The sales offices have a very different feeling and today I experienced the exact opposite of the pink palace, the front line. January 1 is an insurance carriers busiest time of year. Approximately half of your business is made January 1. If that day is not successful, it's next to impossible to recover. 

\With a combination of luck and skill, the Illinois market has been rocking and rolling for January 1. However, there are a finite number of people in the sales department, so I was asked to help with a handful of benefit fairs. This is the place where potential members learn about their options. While I focus on insurance, others may focus on banking, 401Ks, and even Sams Club memberships. A little rusty when I started, by the end I felt like I was back in business school, working on my 30 second pitch. With each encounter, there's a finite number of seconds where someone will listen to you. In those seconds, you need to peak their interest so that they consider the product you're proposing. To a certain extent, the product sold itself. Yet, every so often, I'd get a few tough questions and would have to tell someone directly that the product may not be right for them.

My conversations with the potential members reinforced my thoughts that most people don't understand their healthcare benefits. I don't blame the individuals, I blame the system. The system is quite complicated. Even I, who has a producer's license in life and health insurance, occasionally have difficulty understanding benefits. While I was not happy to be so far from home, it was great to know that I could answer the many questions I received and help people understand the benefits that they are going to be offered this year. The experience gives me even more prospective on the business. Humana Resources and senior leaders may decide which benefits an employee group receives, but then the employees need to understand what benefits fit them. 

Remote Working

Over the weekend of Sept 23rd, yet another friend got married. This time in Connecticut and on a Friday. While I understand the reason people choose Friday weddings, I will be the first one to say that they do bother me. I had asked for the day off, but given that my fiancé was working, I told my boss I could do some work too. What an experience!?!

On one hand, going downstairs to grab breakfast while not feeling that I needed to look overly presentable was quite nice. On the other hand, my computer, which is slow enough on the corporate network, was moving like a sloth while I worked with shared drives via VPN. Definitely painful. Not to mention that my VPN software was having problems so I spent a solid 2 hours in the morning simply trying to get my computer to work. Thank goodness one of my colleagues is also a friend. Otherwise, I surely would have missed my 7:30a central meeting even though I had been up for at least 1.5 hours.

I do think the remote working gets +2 for the amazing Lebanese lunch that my fiancé and I had. Thank you Yelp and Google! It is funny how I rely on these sites so much and rarely contribute to their content. I need to get better! However, a big -5 for the time it took to do anything remotely productive. I can't imagine if I had to use SAS or SQL to pull data. I might as well give up.

The wedding was a blast and the day after I got to experience New Haven's Big Green Pizza Truck. It was delicious and I'd like to export their business plan to Chicago.. and maybe San Francisco.