If we can't get it where we "are" then it doesn't exist. Example, I'm stranded in a desert and need water. I know water exists but I don't have any. So for me water does not exist. Medicaid doesn't pay for every drug that their member is prescribed. If the prescriber insists that their patient must have the drug then they can appeal the denial just like they can with every other denied service. The "EpiPen" brand is strong because they can supply the product. There's no Jedi Mind Trick going on here. If my only choice is one product and there's only one entity that produces that product then ... that's a monopoly. It's real. It exists.

News Flash! If Medicaid is paying for this Brand Name Drug then it is because there is nothing else available (no generics). Therefore they are the only game in town. They shouldn't be but it has turned out that way.

Oh, I only look at the data. The rules on pricing are the lowest price among a few choices (awp, and some other stuff). The point is when this story came out I ran some analysis back to 2007 and looked at: number of scripts, number of people, total paid. This was month by month. No one asked me to do this. I figured since it was political that eventual the state legislature was going to throw a question our way (which they did). The CFO got my report and said "thanks! I sent it over to the pharmacy department to see what rebates we got on this so I would know what our actual costs were." Get my point? We get rebates. If you have insurance then the insurance company gets the rebates since when you signed up for coverage there's a clause that says they are entitled to all rebates. You probably didn't read that. There's also a clause about subrogation. Look it up. If you don't have insurance? Well you get to pay full price, no rebate, no coupon, nothing unless the drug company is shamed into handing it out. My point is: If they are going to give rebates or coupons then why not just lower the price? It's a simple formula, everyone gets the same fair treatment. What's the incentive to keep the price high? What's your guess?

You get your script. You go to the pharmacy. They fill it. They tell you your part is $200. Insurance pays "$400". Then Monthly, Quarterly, Yearly (whatever) the insurance company gathers up all scripts it has paid for and goes to the drug company. They tell the drug company we paid $400 on this script. We want a rebate. Drug company gives a rebate to the insurance company. Your don't see any of it. Insurance company doesn't care how much the drug costs because they know they will get a rebate on the drug. How much is the rebate? You don't know because nobody talks about it. Why give a rebate at all? Why not just lower the cost? Well that would hurt the insurance company. They make money on drug rebates. Drug manufacturers get to make money on high priced drugs. If you buy this out of pocket you won't ever get a drug rebate. You can't negotiate with them. It's nothing but a big accounting scam. You're not supposed to be able to figure this out.

anyone who doesn't know how to run their own email server. You can control your image if you can control everything else. And really it's all about dat image dat image, no substance.

The way I see it. There are two more people to fire and they are the person who made the decision to fire dude and the person who made the decision to fire chick. This did nothing but add to the bad decisions that had already been made and escalated it into a flame war. Of course they'll probably both be quietly hired back and we'll never hear about it as that's not a story.