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Comment by giantg2 | Hacker News Reader

Was there really any gatekeeping going on for this in the first place? Seems more like just about everyone who asks recieves it.

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Yes there is a lot of gatekeeping happening across the board. From my wife's experience living just outside of Portland Oregon:

- Prescription has been cancelled twice for no real reason.

- Pharmacists have refused to give more than one month at a time more than once.

- Even if everyone is on board and not hostile she's only able to get a few months at a time so she has to do this multiple times a year.

I can't imagine how it'd be if we lived in a more conservative state or in a more rural area.

I've had some prescription issue for other meds as well. Usually an issue of the insurance or pharmacy, not a political motive. They don't like to give long term supplies given the expiration is 1 year from manufacture.

At least once she's been lectured about starting a family by pharmacists when trying to pick up her prescription which caused us to switch to a different pharmacy.

It's possible it's all imagined, but I don't really understand why a pharmacist would only give one month when the prescription is for multiple months, or why the prescription can't be for longer as to require less doctors visits / bills. We certainly haven't had the same experience picking up other prescriptions.

"why the prescription can't be for longer as to require less doctors visits / bills."

They aren't just renewing your prescription? Most places see you once, or once per year, and then just keep renewing it.

Most insurances/pharmacies even have partner mail order services where you can turn on auto-renewal and auto-refill. That might be a good option to look into.

Your original question was whether there were barriers. Now you're clarifying you mean political barriers determined by the intent of the provider, which is of course opaque to us. Is it possible under these constraints to describe a barrier you'll accept?

Generic issues are not barriers, especially if they are not universal. There are online services that can cheaply provide these services conveniently. Just because someone uses a provider that provides poor service is not a barrier when alternatives exist.

The one month at a time thing is coming from insurance companies not the pharmacy.

Not necessarily. Pharmacies have arbitrary power.

My doctor gives me a three month prescription for a scheduled substance and I've had a couple pharmacies reject it because it's "sketchy". Of course, they never offer to call my doctor to confirm anything. They just smirk and cross their arms.

Even OTC amphetamines have purchased limits, some imposed by law depending on the state.

I guess you're suggesting that they rejected my prescription because of supply issues, they openly said it was because it was suspicious (3-mo in cash), and also Vyvanse hasn't had shortages like generic amphetamine in 2022-2023.

Also, I think you mean OTC amphetamine alternatives since amphetamine is sched I.

Not supply issues, meth manufacturing suspicion. Yeah, precursors to their manufacture.

These pharmacists have very real personal liability if they end up getting fingered as being a supplier of components used to make illegal drugs. That's why they look askance at this prescription.

Amphetamine (Dexedrine) is schedule II, not schedule I. Doctors cannot generally prescribe schedule I substances like LSD. Pseudoephedrine is a substituted amphetamine so referring to it as "an OTC amphetamine" is technically reasonable although potentially misleading.

Well what do you really expect from pharmacies, when failure to exercise such discretion can get them sued for millions or even billions of dollars? Blame lawmakers and lawyers.

https://www.nbcnews.com/news/us-news/cvs-health-agrees-5b-se...

https://www.npr.org/2021/11/23/1058539458/a-jury-in-ohio-say...

https://www.nytimes.com/2021/11/23/health/walmart-cvs-opioid...

Its more about needing the Dr appointment. A Dr appointment isn't cheap if you are poor and lack insurance, and many places have wait time of a year to get an appointment.

You can get birth control from places that don't require insurance like MinuteClinics and online for a cost of about $20 for the visit. I'm pretty sure the online option does not have long wait times.

This is 3 hours of minimum wage work to get a rubber stamp to get it. Interesting.

Likely much more if you consider the actual cost of the medication.

Last time i had to pay out of pocket (because insurance won't cover more than 3 months at a time and I was going out of the country for 6) my GENERIC BC was 89.99 per month. The brand name is something like $189. I can't take cheaper forms because they have negative interactions with my brain chemistry that make me suicidal. BC is offensively expensive and needlessly difficult to obtain.

As an aside, the amount of patronizing in these comments along the lines of "but these women will clearly take the medicine wrong or fail to understand the consequences of their actions if we don't have them speak to a doctor first!" is just... really telling.

One of the routine problems I see around this place is how the folks who flock to "intellectual" spaces are both the intellectual and the ignorant who fancy themselves the former's equal.

I'm terribly sorry to have read your experience. I empathize deeply, though my situation is different (migraine medication vs birth control), in my experiences in having dealt with doctors and insurance companies to get both the medication I need and in an amount that will get me through.

I hope this change and others like it help bring you comfort and safe, affordable access to medicine you need.

In some states in the US, sure. But that requires you to both be in a state that is served by the service, know that it exists and is available, and still pay out of pocket.

Availability and discovery are absolutely massive to health services. Most people don't know about their options, and many more don't even have the option in the first place.

Having this be OTC is a massive step in that regard.

Let's make people go to a clinic to get any medicine then. If it isn't such a hassle, you won't mind?

I have a feeling you might be the type of person to think government should get out of the way of most things. Why is it not such a big deal in this case?

I generally am in favor of government getting out of the way. I'm not necessarily against this being OTC either. I think a lot of the arguments being made here are not applicable and this won't be as big of a deal as people are making it out to be. I'm skeptical that this will bring any real net benefit over the current state.

That said, I do believe there is a massive overuse of hormonal contraception which is partially contributing to several negative factors in society right now. This should be addressed through education and informed consent (the Rx process isn't really doing this either, so...).

You are letting one ideological belief conflict with another and yet you don't realize it. When you feel strongly about something, don't excuse it like "I think a lot of the arguments being made here are not applicable and this won't be as big of a deal as people are making it out to be."

First of all: are you the person affected by this change? If you aren't, try and imagine being a person that was. If you cannot empathize at all with the other side, perhaps it isn't something you should be arguing for or against.

Second: does this vibe with how you would treat someone you normally would disagree with politically, if the position were flipped? Say there is something you think government shouldn't have a say in (apparently not family planning, but you can think of something... guns? business?) then have them argue 'it isn't such a big deal to have to jump through this bureaucratic hoop and the reasons we make you do this is are obviously not as overt as we pretend'. How would you feel about that argument?

Yes. I have had several friends who saw providers at a local Catholic hospital system and had those providers refuse to prescribe birth control.

Ok, I can see that case. Why not use the online services for $20/visit then?

You are a teenager who needs oral contraceptives because you are sexually active. You don't want your parents to find out. Since you're a teenager, you have a few constraints:

- you have no car, how do you get to your doctor's appointment without asking parents for a ride?

- you are a minor, do you have any guarantee that your doctor won't tell your parents? You can't risk them finding out, they are very conservative

- you may not have ever made a doctor appointment for yourself before, maybe don't have access to insurance information etc

Planned Parenthood provides BCPs at a price you can afford with your teenager job (also guarantees privacy) but the closest one is hours away...

What do you do?

Spotted the person who's never been without health insurance.

You still require payment for OTC. You can get birth control from places that don't require insurance like MinuteClinics and online for a cost of about $20 for the visit.

Correct. We, the high-tech HN crowd, often forget about third world countries with terrible healt care.

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