“Affordable”: Prescription Meds May Take Hit Under Obamacare

The hit parade grows

(The Blaze) First some consumers found they couldn’t keep their existing health insurance plans. Then others learned they couldn’t keep their doctors. Now it’s possible that under Obamacare, some people won’t be able to keep their medications, or at least not afford them, under the complex formulary structure of the plans on the health exchanges and because of the rising costs.

“If you like your medicines, you may not be able to keep them under Obamacare,” health policy analyst Scott Gottlieb wrote in a Forbes column. “Health plans are cheapening their drug formularies — just like they cheapened their networks of doctors. That’s how their paying for the benefits that President Obama promised, everything from free contraception to a leveling of premiums between older (and typically costlier) beneficiaries, and younger consumers.”

Much of the coverage will be determined by which plan level (bronze, silver, or gold) is chosen by the consumer….thought: I wonder if we will be provided with what the mix of plans chosen is? Those silver and gold plans are pretty expensive… as well as whether the plan explicitly mentions the medicine

In some cases, to be covered at all, the drug will have to be included in the plan — similar to how doctors must be part of a network covered by insurance, he wrote.

“The out of pocket caps on consumer spending only apply to costs incurred on drugs that are included on a plan’s drug formulary,” Gottlieb wrote. “This is the list of medicines that the health plans have agreed to provide some coverage for.”

So if it is not mentioned, consumers are on their own. And if it is covered, then the copays will eventually kick in, and the copays can be high. Prescription meds are one of the “10 essential benefits” of the ACA, but like so many other things, insurance companies have to reduce costs and coverages in order to make sure costs are regulated and do not explode.

The Washington Post’s Ariana Cha attempts to be helpful regarding meds, surely a direct response to the original Forbes article, and unintentionally highlights that the coverage is a mess, not finished yet, and hard to understand. Much like the entire law. But Cha also notes in another article that the Obamacare plans are also skimpy on coverage for AIDS and other medicine

Some plans sold on the online insurance exchanges, for instance, don’t cover key medications for HIV, or they require patients to pay as much as 50 percent of the cost per prescription in co-insurance – sometimes more than $1,000 a month.

As the details of the benefits offered by the new health-care plans become clear, patients with cancer, multiple sclerosis, rheumatoid arthritis and autoimmune diseases also are raising concerns, said Marc Boutin, executive vice president of the National Health Council, a coalition of advocacy groups for the chronically ill.

This is what happens when the focus is on simply controlling healthcare costs in a politically expedient manner while forcing people to either obtain health insurance or pay a fee/fine/tax. This is why deductibles are high, doctor/medical center/hospital networks are limited, and now we learn about problems with prescription meds.

Crossed at Pirate’s Cove. Follow me on Twitter @WilliamTeach.

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