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joined 4 months ago
[–] ___@l.djw.li 4 points 3 months ago

Underrepresented at best, at worst it’s arguably too easy to forget that Alpine is more than just container images.

Not sure how to solve that problem, it’s my go to for rolling an image but wouldn’t normally make the shortlist for standalone machines. In a prod env, that’s basically Deb, RHEL derivatives, etc. In a personal env for me, Arch derivs tend to win out on non-critical services if only because I invariably learn something useful that I wouldn’t want to learn in prod.

[–] ___@l.djw.li 4 points 3 months ago

That sounds like true freedom, and also like something I wish deeply that I had time and energy to make my daily driver - I’m a purist, but I’m also a pragmatist and i can feel the burnout already.

Respect for using it as a daily driver - even for a personal only machine, that’s a pretty high bar, especially long term.

[–] ___@l.djw.li 2 points 3 months ago (1 children)

It does sound horrific, but mostly because it would be poorly executed by many devs.

Well, and the seeming trend towards install commands that look like curl $file.sh | sh

But if they’re not actively encouraging that, I see no issue with a well maintained install tool, created from well maintained toolsets that work on essentially any platform.

[–] ___@l.djw.li 15 points 4 months ago (1 children)

I went into a smidge more detail over on my Mastodon last night, but my response is summed up as “WTAF? No! Freeware is an explicit license, as anyone from the BBS days will recall.”

[–] ___@l.djw.li 1 points 4 months ago

After you spend down your allotted PTO, yes.

Mildly surprised that someone in a position at that level wouldn’t have at minimum short term disability coverage, at least as an option. It’s hardly expensive.

[–] ___@l.djw.li 3 points 4 months ago

Just too easy to get over a barrel trying to DIY it, and the first time ya screw it up, you lose a ton of credibility with employees which also has a great deal of value.

[–] ___@l.djw.li 1 points 4 months ago

Ironically, there are two newer formulations and the older soon to be authorised generic. My PBM in their infinite wisdom doesn’t want to cover the cheaper one. My doc has yet to get a PA approved for anyone for the newest version, so I’m stuck with the version they foisted upon us as soon as original exclusivity expired “because sodium raises BP,” and the newer one is salts with other metals.

Funny how they didn’t figure that out years ago……

[–] ___@l.djw.li 1 points 4 months ago

Unfortunately not an option for specialty and niche drugs. Wish it was, I’d rather him get a cut than a certain PBM

[–] ___@l.djw.li 2 points 4 months ago

I’m mildly curious to see what happens in the next month or two, as I’m about to hit my OOP max. Never ran into that combo of scenarios before.

The one I’m thinking of has a couple months “bridge” program for uninsured/just started new job/etc, but very time limited and an even bigger hassle as they’ll only send out two weeks instead of a month supply with each shipment.

IIRC, if I had insurance and it explicitly excluded the drug, the card would cover it, but it’s been a couple years since I left that job so memory isn’t clear.

[–] ___@l.djw.li 1 points 4 months ago

None of is trustworthy. Mine is $$$$, and they know damn well insurance won’t pay it all. Of course, if the FDA didn’t require a single source pharmacy to ship it with all the infrastructure that entails, it would help, but only marginally.

Nightmare of a system even for relatively healthy folks. The older I get, the angrier I get because the people who most need the help are the ones either in enough pain they can’t nav the system, or old enough they don’t know where to start

[–] ___@l.djw.li 1 points 4 months ago (1 children)

Nobody is buying the med I have in mind out of pocket, in any world. Orphan drug, rare condition, and six figures a year.

Not to suggest your scenario doesn’t happen - it absolutely does. But I’m more curious about why I have to deal with a tiny company when they’re already eating a couple of grand a month on it.

[–] ___@l.djw.li 1 points 4 months ago (1 children)

It’s not a physical card always, it behaves like a secondary insurance payor, and if a $5k drug is covered for $2.5k by insurance, the card writes down the difference to $5 (as far as the patient is concerned).

Not unlike goodrx in principle, but specific to a drug.

 

This is very, very niche, but I couldn’t think of a more suitable place so I’ll give it a go.

In the US, brand name medications are outrageously priced. There are deals between payors (PBM/Medicare) and manufacturers that look like this:

Sticker price $20,000/mo minus negotiated insurance payment of $15,000 theoretically leaves pt on the hook for $5.000/mo, BUT…

Manufacturer graciously offers a “coupon” / discount card, which covers a max of $4,995.00, leaving pt with a net responsibility of $5.00/month.

These are convenient numbers to work with, but closely resemble the pricing and coverage structure of a long-term medication I take.

The coupon never results in zero pt responsibility, always leaving some negligible amount due. Invariably, it’s exactly enough money to be a huge pain in everyone’s ass and to make no meaningful difference to anyone involved in the transaction. $5.00 and $9.00 are amounts I see frequently.

Getting to the actual question, why bother?

Seriously, I wasted a half hour of my life waiting on hold to schedule a refill on a specialty med that can only be filled from a single central pharmacy and shipped, to be told that a) they somehow didn’t charge card on file for the $5.00 last month, and b) can’t schedule next shipment until I pay the all-important five bucks. Didn’t have a card close at hand, had to call back later so they could extract their couple dollars and then schedule the next round.

It literally costs them more in toll free charges, infrastructure fixed costs, and salaries to collect that money than they make from it.

I assume the answer is something along the lines of “personal responsibility” and someone in Congress having a stroke over the idea of someone getting medicine for “free,” but I’ve been unable to substantiate that.

Convinced there is a reason, probably buried in a 10,000 page CMS policy manual, because the mfg coupon literally never brings the price to zero. See, e.g., DTC drug commercials referencing “pay as little as $x a month!”

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