Big Pharma vs US citizens

Dear Dr Ghobrial,
Thank you for sharing your talent here.

This really captures the essence of the frustration and sadness we see patients experience daily.
I am a nurse. In transitioning from inpatient to outpatient I’ve been forced to become an expert on getting PAs, formulary exceptions, tier exceptions for the patients in my practice. Due to the nature of the specialty, the medications are truly life or death, and the substitutions offered by insurance would be laughable if the consequences were not so dire.
We spend hours on the phone fighting for these patients we care deeply about. Last week an insurance company would not budge on a critical medication. A PA request, an appeal, a peer to peer all denied. In the end we had to bypass insurance as I found a pharmacy discount card which brought the cost to the patient to a manageable level.
I saw my own PCP recently only to find that my long time inhaler was denied by my own insurance (formulary changed!).
Unfortunately it’s not affordable and the substitutions are covered but with an exorbitant copay. It’s quite astonishing that am ER copay is one third of the cost the cash price of the inhaler.
I would love to see more of your work posted here, it’s very timely.