24 posts shown.
Maria Fisher46 said:Atypical lymphocytes (over 10%) and a liver lesion... Could there be elements of infectious mononucleosis here? Should we look into testing for EBV and CMV?
You should definitely have those cortisol levels re-checked. It’s entirely possible you'll need a full endocrine workup—things like checking ACTH or running a dexamethasone suppression test. An ultrasound of the adrenal glands just isn't enough to rule out more subtle pathologies.
I'm really glad Nicholas Myers stepped in here, because my own expertise is pretty limited in this area—honestly, interpreting blood work isn't exactly my specialty. That said, I should point out that certain results can shift due to various diets, intense physical exertion, and things like that. I'm not sure if your doctor actually performed a clinical exam? Are you dealing with excess body fat, or perhaps issues with weight? Regarding the cortisol findings, I didn't even catch that part. 🐔
What I mean is—I'm no expert—but I really believe it's a mistake to look at lab results in a vacuum without considering extra context, like being on a restrictive diet or having pushed yourself through an intense workout just a few hours before the blood draw. Various lifestyle factors and behaviors can totally swing your blood work.
Also, please make sure to keep your old records (like from a year or two ago) so you can compare them against the new ones. That's how I handle my own health tracking. Wishing everyone nothing but good health, and sending my best to Dr. Felix! 🙂
Justin Phillips15 said:Is anyone else seeing this?
My doctor told me at the clinic that it’s just some kind of viral thing... she wouldn't even give me a referral for more blood work—just told me to call back in a month if I start feeling worse.
Did you get your Sed rate or CRP checked? Your transaminase levels (liver enzymes) are pretty high—could be from medication or maybe too much alcohol? You also have an elevated white blood cell count. Honestly, looking at those numbers, I'm leaning toward a bacterial infection rather than something viral.
I'm a dentist by trade, so someone with more experience in general practice could probably give you a much better breakdown.🤔
By the way, it doesn't look like an immediate emergency, but if I were in your shoes—especially if you've been drinking—I'd cut out the alcohol entirely for now.
I wouldn't be at all surprised if hormonal imbalances are actually the root cause behind most anxiety cases. Of course—it’s not one-size-fits-all; depending on the specific imbalance, one person might react with anxiety, while someone else might spiral into aggression or depression. So, really, it boils down to this equation: hormonal imbalance + genetic predisposition + personality type + environment = the final reaction.
Amanda Vaughn3 said:India churns out generic cancer drugs and treatments for HIV diseases, but I highly doubt they'll ever reach American patients—mostly because those generics are essentially produced under the radar, bypassing Big Pharma patents on the latest breakthroughs.
Since Medicare burns through massive amounts of cash on cutting-edge meds—some clotting factors can hit $100,000—
it might be worth looking into importing generics from places like India or Brazil; we're talking about "copies" of modern drugs that haven't officially cleared their patent windows yet.
And where do you think all the drugs from EU countries—or at least the active ingredients—are actually manufactured?🙄 Let's be honest, the pharmaceutical industry isn't exactly known for being "clean" or eco-friendly.
Any medication approved by the FDA is legitimate. Take Valium, for instance—that's just a copy... cheaper drugs are cheaper simply because they don't include the massive R&D costs in their price tag. Aside from that, they are 99.9% identical to the original. Sometimes, generics even have fewer side effects than the brand names (likely due to the nocebo effect). What I'm seeing here is a classic mantra used by the original manufacturers—something I remember vividly from my old days—which basically goes: "Always insist our drugs are the 'originals' and everything else is just a 'copy."😂 The only "problem" now is that many of those original companies have dropped their prices to be lower than the generics themselves. Of course, after ten years of monopoly, they've already recouped their research costs, so it's completely nonsensical not to offer the drug at the same price a generic company would.😁
George Allen71 said:I'm really hoping they finally grant it to me at 9... right now, we're just stuck waiting on whether they'll approve it through an appeal, since everything is supposedly changing. Honestly, it actually terrified me... I had this gut feeling she just didn't want to give it to me, which is something I've truly never experienced from her before. Regardless, I made it clear to her: I am going to fight to get everything I'm entitled to and push this through... not just the referral, but the surgery itself.
I just don't understand why she refused to give me the referral today, or what on earth I could have possibly done differently to make her comply. It's not like I can go in there and try to teach a doctor how to do their job. How is a patient even supposed to carry themselves in a situation like this?
If a patient decides to confront a doctor who isn't doing what they're supposed to be doing,
effectively threatening to go to the media and name names is an option. But honestly, forget about the medical board, the American Medical Association, or Medicare. 😂 Just because someone announced that things are changing on September 1st doesn't mean those rules apply right this second. 😠
Some doctors are truly bringing shame to their profession. If they're so afraid of being called out by Medicare, then they should just cancel their contracts and start working in private practice. Things like this genuinely infuriate me. I have my own doctor, but she won't even argue with me once she realizes that pushing back isn't the smart move. 🙂
Amanda Chavez27 said:I’m only asking because there’s some vague talk about whether it's actually true—this idea that you’ll only get four specialist consultations after being discharged from the hospital, and after that, everything falls back on your primary care physician.
My GP has always sent me to the Mayo Clinic for psychiatric evaluations, and they simply follow whatever treatment plan the specialists dictate, specifically applying the medication dosages prescribed by those experts.
I should point out that, as far as I know, my doctor only orders certain medications specifically for my case; I’m essentially the only patient in that entire clinic receiving this particular therapy.
Honestly, I believe they’ll still be referring you to specialists if there's even a slight suspicion that your medication dosage needs adjusting. I’m assuming you’re on a long-acting depot preparation (getting those injections)? It’s going to be incredibly difficult for a general practitioner to step into psychiatric cases (F.20-29), and the same logic applies to some of the more severe medical conditions. So, really... there's nothing to fear. Besides, things aren't actually going to change *that* much.
copperlynx22 said:It seems we aren't quite on the same page here.
vividsailor7 mentioned a situation where a primary care physician refused to prescribe a more expensive therapy to a patient who arrived with a specialist's recommendation, but if I understood correctly, that wasn't actually about generics. Back before the current reforms, Medicare eventually sided with the specialist.
I believe his concern lies in the possibility of such a scenario recurring. It isn't a matter of whether someone receives Bayer Aspirin or Pfizer (to use a loose analogy), but rather whether a patient can access an insulin analog if their endocrinologist determines it is necessary over standard insulin—or if a GP will deny the prescription simply because they deem the switch unnecessary.
I won't get bogged into the technical nuances between analogs and non-analogs, but the crux of the matter is that analogs lack generics and cost twice as much, even though they are all included on the essential drug list.
In my view, any instance where a primary care doctor ignores a specialist's opinion is definitely not in the patient's best interest—and it certainly shouldn't be allowed. I just hope that primary care doctors will be smart enough to argue with Medicare rather than causing harm to the patient. At the end of the day, a hospital specialist has a documented medical history where they can write a prescription that might even deviate from Medicare guidelines, provided it’s backed by their expert opinion. In fact, they don't just have the option—they
must . However, since this discussion was opened specifically because of the confusion surrounding "cheapest" medication options, I don't want to veer too far off track. An analog of a drug is not the same as the prescribed drug; it's essentially a different drug under a different manufacturer's approval. No matter how similar the effect might be, it is a different medication, and I truly hope primary care doctors won't swap out what a specialist has prescribed.
Amanda Vaughn3 said:It's an insurance thing.
Hospitals have security—at least the Mayo Clinic does—whereas health centers pretty much don't.
Look, you can find psychiatrists in plenty of community health clinics across America. What do you mean, "insurance"?😲
Elizabeth Fowler46 said:Is there going to be any shift regarding the other doctors in primary care? Basically, can my gynecologist still write me prescriptions or lab referrals, or is that all going to have to go through the AMA now?
It seems like OB-GYNs working in primary care are still stuck in the old way of doing things—just like the dentists. Honestly, they aren’t crazy enough to go around trying to change the system now.☕
vividsailor7 said:Look, I couldn't care less about Medicare's guidelines. Honestly, their rules don't affect my life one bit, and frankly, I have zero interest in whatever kind of relationship they have with the American Medical Association. It’s all noise to me.
As for actually punishing these specialists? Honestly, it’s just not going to happen. You might be able to squeeze some accountability out of the smaller local clinics, sure, but trying to go after someone at a major institution like the Mayo Clinic? Forget about it. There isn't a damn chance.
On top of that, they’ve had that option to enter the LOM code since around November of last year, and as we can clearly see, absolutely nothing has changed. Not a single thing. That dentist is just all bark and no bite—nothing but empty threats.
And if—by some miracle, which I find absolutely impossible—they actually go through with it, I’ll be more than happy to send every single patient scheduled for a colonoscopy or an EGD straight to Medicare, just like they do with that insignificant dentist.
It’s not that I’m being unreasonable—it is actually exactly the opposite. They are the ones being completely reckless and irresponsible because they refuse to dispense the medication.
I honestly don't get it—how on earth can a doctor just accidentally prescribe a medication? Seriously, how does that even happen?
My own family can't even get online anymore—they've basically degraded themselves to the level of an SKZZ clerk.
I’m going to say this one more time: Medicare and its endless, bureaucratic rules have absolutely nothing to do with me!
When it comes to how everyone is working together on this, first off, the SKZZ is completely unified. As for the meds and those internal prescriptions? Honestly, only a few smaller hospitals are even handing those out—I’m not even sure if anyone in a major city like New York does that anymore.
To answer your original question: honestly, when I deal with most doctors, clinics, or medical institutes, I rarely run into any issues at all. It’s just a matter of finding the right people.
I've had enough.
The whole damn Mayo Clinic is talking about my post, and now it’s been tossed straight into the trash.
Sir,
I honestly don't understand why you feel the need to use such a tone. I will admit, I agree that "that dentist" is mostly just blowing smoke because he can't actually do anything to hospital specialists (other than, of course, the state adjusting your on-call pay slightly)—but this affects all of us working within the system in one way or another. If I—someone working in the pharmaceutical industry—am saying this to you, who is right there on the front lines, it isn't because I'm trying to play the hero. It's simply because I know how hard all of you work and how much of yourselves you pour into these patients. So, what does it cost you to meet them halfway when the system fails them?
Brandon Lopez6 said:It's not available in every city, though. In Sisak, there's only one (I repeat, ONE) psychotherapist working, and she's a psychologist, not a psychiatrist—which basically means you're screwed. And yeah, she works with kids and teens, so anyone over 18 is stuck choosing between Popovača or driving all the way to Washington, D.C., especially since there isn't even a bus running to Popovača. Figure it out yourself, buddy.😍
And don't even get me started on the smaller towns, because Sisak isn't even that small.
From what I understand, there are five psychiatrists at the Sisak Hospital and one more in Petrinja—with at least three of them specializing specifically in psychiatry. My point was that it would be much better to have psychiatric services located at the PZZ (just like general medicine, OB/GYN, and dentistry) because there's really no reason for these clinics to be tucked away inside hospital buildings.
melloworca6 said:I don't want to drag this debate out on that other thread since it's already blowing up here, so I'm moving the quote over.
And this isn't being "okay" toward your colleagues. 🤷 Sorry, but Medicare is king here. It's not like we have some other independent agency to turn to, so we're stuck with them, and apparently, you think you can just pick favorites. If they are the authority and they say a drug can't be covered without paying out of pocket, and you intentionally write prescriptions for drugs you know aren't on the basic free list—and then you go as far as telling patients to sue the medical board—then you're just being disrespectful to your peers. Honestly, it doesn't surprise me that they hang up on you or act rude.🤷
We all know how drugs get added to the Medicare list. You should all get together and pressure them to include what the experts actually recommend instead of screwing over the patients. As if being sick isn't enough, we don't need doctors fighting amongst themselves and pitting people against each other.
Look, Hrvoje, I get that you write what you think is best, but damn it, we don't live in a utopia. You can't just take the "not my problem" approach. How are you supposed to collaborate with other specialists when things get serious and require a team effort if you're busy bickering over fucking medications?😢
This is absolutely true. A general practitioner
shouldn't be prescribing something that goes against Medicare guidelines. A hospital specialist should be fully aware of those protocols; instead of passing the buck to a GP and saying, "Well, let them deal with the headache and explain it to the patient," they should be warning the patient that while they believe a specific therapy is better, it unfortunately isn't covered for free under current rules. If you truly believe the Medicare guidelines need to change to match modern treatment protocols, then send a formal petition to Medicare—or better yet, write to the medical boards and get a story out in the news.😁
Nicholas Myers said:Well, I see what you mean ( : OKP : ), but I have no idea how to split or merge posts without making a total mess of things.
The topics are clearly linked.
I think it’s best to just leave it as is for now. We'll see how it plays out.
That said, I agree with your observation; actually, I wrote something very similar on another thread.
vividsailor7, I hear you, but I think you're missing the mark on one point. This isn't about the AMA being stubborn (though, granted, some of your examples involve both stubbornness and unprofessionalism, but that's beside the point)—it's about the fact that they'll be penalized if they don't follow orders.
Think about it this way: if you were supporting a family on your salary and someone threatened to cut your pay in half or fire you, would you still pick a fight you can't win, or would you just do what you're told?
Suppose Medicare decided that any specialist who doesn't prescribe medication strictly according to their specific guidelines would face a pay cut. How would you react then?
I am sorry for starting a new thread, but I felt it was necessary to explain to patients that "cheaper" medications aren't necessarily lower in quality—and in many cases, the brand-name originals are actually among the top five most affordable options.
I also want to touch upon why—at least in my estimation—the Secretary made that statement. Prof. Ostojić is far too brilliant to make such a comment just to scare patients. However, we have to realize that Medicare—essentially, the government—owes a massive amount of money to the pharmaceutical industry (the pharmacies, the wholesalers, and the manufacturers). It is in Medicare's best interest for drug prices to drop as much as possible. Therefore, the statement that only the cheapest drugs will be listed is essentially a signal to Big Pharma to: 1. Lower their prices, and 2. Stop insisting on immediate debt repayment and instead agree to a partial settlement (not to mention the interest, which I won't even get into).😂
Nicholas Myers said:Hello,
I took the liberty of tweaking the title; I hope you don't mind. 🙂
It would be helpful if you could edit your post to include some spacing between paragraphs. It would make your points—which are actually worth reading—much easier to digest.
Thanks, Nicholas—the title is fine. I was writing in a rush and feeling pretty heated because I genuinely believe it’s wrong for the Secretary of Health to mislead patients with his statements. Look, if someone told me they were going to fill my high-end car with nothing but the cheapest possible oil, I’d be worried and angry—especially if I’m still paying full price for the service. It's perfectly reasonable to expect clarity. Someone outside the medical field shouldn't be expected to understand the nuances of medication any more than I understand engine oil specifications. That’s why I felt people needed a deeper explanation of how (and why) these things work. Of course, I'm not trying to take sides here—even though I actually work in the pharmaceutical industry—because at the end of the day, I'm just a patient using medication too.
Nicholas Myers said:I don't think the new model will change much regarding referrals in your situation; essentially, your primary care physician will likely still be sending you to a psychiatrist.
From what I understand, family practitioners aren't trained to perform psychotherapy—at most, they might handle some surface-level therapeutic interventions. There may be rare cases where a doctor has pursued extra training specifically in psychotherapy, which isn't strictly a field reserved for psychiatrists.
The only gray area is the detail about hospital access. I haven't seen any clear guidelines outlining the specific criteria for which facility a patient can be sent to. So, as for whether you'll be able to receive treatment in Washington, D.C. via a referral, I can't say for sure.
But, as I've mentioned before, under this new model, I doubt anyone is going to force a primary care doctor to stop referring patients to specialists.
There’s also the option of having psychiatrists available through the PZZ—just like we already have gynecologists and dentists. It’s a safe bet that we'll see more of them once some of those specific psychiatric wards in general hospitals are eventually restructured. Right now, there are roughly 500 psychiatrists in the US, and honestly, a huge number of them are just stuck in hospital bureaucracy without actually doing much of anything. Their specialization takes four years, after all—and let's face it, severe psychoses are typically handled via hospitalization anyway, or through outpatient care if they're in remission. For everything else, day hospitals are right there. BTW—just give private psychiatrists a shot at the capital, and you'll see how quickly things start moving.😉
Prompted by recent news headlines and TV segments—and given that I've spent quite some time working in the pharmaceutical industry—I feel a profound need to explain something to people that should have been clarified long ago by our sole, mandatory health insurer, Medicare. So, here's the deal: as of September 1st, primary care physicians aren't just being encouraged; they are actually being instructed to prescribe the most cost-effective medications that share the same chemical composition. We're talking about drugs that possess the exact same active ingredient as well as the same excipients. Essentially, when a company first brings a drug to market—after pouring massive resources into years of research on rats and humans—they hold an exclusive monopoly to set the price. But once that patent expires, they have to face reality: other generic manufacturers step in, utilizing those initial research findings (which was the most expensive part of production) to drive the price down. On the Medicare formulary (those "free medications" for patients), we have but not for every single drug , both the original brands and the generics—which are copies that must be 99.9% identical to the original, from the active substance to the inactive ones. Sometimes the original brand is more expensive, but in most cases, the company that pioneered the drug lowers its price to match the generics. Furthermore, it can actually happen that the price of the original brand ends up being cheaper than the generic version .
Another thing: on the drug formulary, alongside the medication itself, you'll see the NAME OF THE MARKETING AUTHORIZATION HOLDER listed here in the US. This means a situation can arise where one manufacturer has their drug on the list, yet they've actually licensed the right to sell that exact same drug to a competitor.
To give you a concrete example, let’s look at atorvastatin, a drug used to lower cholesterol. There are 14 different versions of it on the Medicare list!! 😲 At least 8 of those are priced identically for the same package size. So, which one will a primary care doctor pick? Any of them—they all cost the same.
Now, for those who feel very strongly about using only the "original" brand: okay, if you want Valium, you wouldn't ask for Normabel. But neither of those is actually the original!! Both are diazepams, and only Valium is from Roche (and it hasn't even been on our market for about 30 years) 😁
Innovative "originator" companies, in their hunger to maintain market monopolies, often have their representatives convince people that their drugs are superior—that they have "higher quality" active or inactive ingredients compared to generic firms. That sounds great, except sometimes (and increasingly often) they end up selling the rights to their own drug to another firm. It's similar to what Pfizer did with Zithromax. Where is Zithromax being produced now (under Barun Filipović)? 😂
The crucial point for all of us to remember—and I am a patient myself—is that any medication that has passed the rigorous checks of the European Union agencies, the American Pharmacists Association, and the FDA, fully meets the properties of the very first original drug... even if that original isn't even manufactured anymore. When I had to buy a medication abroad because it wasn't available here, I didn't mind paying $67. Later, when that same drug hit our market (though not on the basic formulary), I was just happy I didn't have to drive to Canada to get it, and I only had to pay $50. Eventually, that same drug appeared on our standard formulary for $20, and I didn't have to pay out of pocket anymore. Thank God for that medicine!!
To make this clearer for anyone reading this: the announcement that primary care doctors must prescribe the cheapest options is likely a message to those of us in pharma not to go chasing the debts the government owes us. As for anyone exploiting a patient's lack of knowledge... well, may their conscience handle that. Just like everything else.....
P.S. Admins, please don't move this post unless you consider it pretentious or malicious.
melloworca6 said:Unless they start slapping on more restrictions—like strict mandates or tracking exactly how many times a doctor checks in on a patient—I highly doubt the primary care office is going to shoulder that much liability just to go against what a specialist recommends. 🤷
I don't see any reason why anyone would bother doing that unless Medicare is breathing down their neck and throwing penalties left and right—but hey, we'll see how that plays out.
Morgan Morgan5 Asks:
It honestly makes me sad when people who don't have a clue about the profession start posting their opinions without doing any actual research first. Whether they’re doing it on purpose or just being lazy, they end up spreading nothing but misinformation. You see it all the time with journalists today—the hacks at the local news stations and those big cable networks. As far as medications go? Nothing. Absolutely nothing important is actually changing. For the patients.I'm talking primarily about prescription drugs—not the stuff they just hand out to you in a hospital ward. If prices actually drop, the pharmaceutical companies are going to take the hit first. And that’ll ripple right down to the doctors, too, since those big pharma outfits are the ones footing the bill for their "educational" seminars (or, let's be honest, just paying for their trips).
Look, we patients all read the same sensationalist garbage in the papers. The way they write things makes everything sound so murky just because they need clicks. I’m not exactly an expert—I'm definitely a layman—but I know enough about how things work to realize I totally misread the text. What do you think it’s like for someone who hasn't a clue how any of this works, especially when their only source of info is some tabloid churning out the same nonsense?
We’ll just have to wait and see how much this new policy ends up crushing the patient. All this back-and-forth between specialists and the insurance providers—it’s the patient who ultimately pays the price. It’ll be interesting to watch once the insurance companies get the final word on everything. Truth is, plenty of things are already being swept under the rug. Terrible stuff that people mostly stay quiet about. You know how it goes: there are limits on certain tests and caps on specific medications. You end up waiting two or three months for a basic lab test because they ran out of reagents or blew through their monthly budget. Or you have oncology patients sitting around waiting weeks for their treatment because the monthly quota was hit and the funding for those drugs just ran dry. It happens.
You aren't going to convince me that we won't feel the fallout of this. Every single time they roll out some new reform or set of regulations, it’s the patients who end up paying the price.
Unbelievable. Apparently, this new regulation kicks in on September 1st, so let's just sit back and see what "wonderful" surprises they have in store for us. And look, I'm with you on one thing: I honestly don't care what a drug is called as long as it works and doesn't wreck my body. I couldn't care less if it's the brand name or a generic, unless that cheap version actually performs worse.
edit: And get this—over on the other thread, people are saying exactly what I've been hammering on about here. They're claiming Misar hits harder than Xanax or Helex. Yeah, I get it, it's the exact same medication under a different name, but clearly, for some reason, certain people respond better to one brand over another in the same class. How? Why? Is it a placebo effect, or are they lying to their doctors? 😁 I don't know, but it's not the first time I've heard someone swear that a version from a different manufacturer works significantly better.
I've felt that tension myself—the back-and-forth between general practitioners and specialists, bouncing from one to the other and finally ending up at a Medicare commission.🙄
It’s certainly not going to get better. There's going to be massive scrutiny regarding medical leave. You truly realize drugs are identical when you're paying for one out of your own pocket, say $50 every month, and then you find out there's a generic equivalent (the same drug) that you could pay $20 for instead. Otherwise, you have to consider the nocebo effect. Patients can actually experience side effects from a "medication" that doesn't even contain an active ingredient.
In the US, some medications are dispensed by number (how antibiotics used to be handled) in plain paper bags. They list the generic name, not the brand name on the approval.
The media writes these sensationalist pieces, the journalists are unprofessional, and frankly, often even the people who should be providing accurate info don't know it themselves. In the end, neither the hospital specialists, nor general practitioners, nor even those in pharma—and I firmly believe most people at Medicare too—have any idea what is actually going to happen after September 1st. From experience, I know it won't be anything sensational.🤷
The patent holders always have the luxury of dropping their prices whenever they feel like it. Honestly, they’ve been skimming the cream off the top for years now. If patients were forced to pay for their medications out of pocket—much like how people shell out cash for herbal supplements or gourmet candy—they’d realize pretty quickly that it doesn't matter if the chocolate comes in Hershey's packaging or some other brand's wrapper. It's the exact same chocolate. 😂
So, any truly innovative, one-of-a-kind drug that makes it onto the coverage list is going to maintain its premium price point. Even as it stands today, you can still find cases where the original brand-name medication actually costs less than its generic counterpart. 🙄
melloworca6 said:Honestly, reading this from a doctor is just depressing. You guys know perfectly well that in medicine, two plus two doesn't always equal four. There's so much we still don't know, and half the time, treating rare conditions is basically just trial and error.
And since when did "official medicine" become some unchangeable holy scripture? Why cling so blindly to every single word in a textbook? 🤷
It’s honestly heartbreaking when people who lack any actual expertise start posting about this without doing their homework first—whether they're doing it intentionally or not—and end up spreading misinformation. You see it all the time today with journalists, especially those at major networks like CNN or local news stations. As far as medications go, absolutely nothing significant changes
for patients. I’m primarily talking about prescription drugs—not the stuff administered in hospitals. If prices drop, the pharmaceutical companies are the ones who will feel the hit, followed by the doctors whom those companies help fund for "educational" purposes (or, let's be honest, just to pay for their trips).
Here is what happens when someone who actually should be explaining things clearly to patients either doesn't know how—or simply refuses to. I am, of course, talking about Medicare and Prof. Ostojić. Essentially, primary care doctors are going to be forced to prescribe the cheapest option available. But here is the catch: every time a new drug hits the formulary, the prices for everything else tend to drop—which affects most people. We end up with lists containing ten completely identical medications from different manufacturers, or rather, different patent holders. To be specific, there are drugs where both the original manufacturer and another license holder stay on the list. So, it is the exact same medication at the exact same price—just a different name and a different box. For instance, Lipitor has 14 versions on the list, and most of them share that same lowest possible price. When it comes to certain medications, patients don't have even the slightest clue which one is the actual originator. I would love for someone to chime in if they know what the original Diazepam is (like Valium). If you Google it, see if the original brand is even still on the list.
So, for patients, nothing really changes regarding the medications on the basic formulary. As for specialists—the ones pharmaceutical companies fly out to symposia and medical conferences—what will happen is they'll have to coordinate much more closely with the firms that offer the cheaper drugs. However, since there are at least three (if not more) versions of these drugs on the Medicare list, and the choice is left to general practice, it is pretty obvious that general practitioners will be the ones traveling more often.