Posted on 02/16/2014 8:59:13 PM PST by 2ndDivisionVet
Along with Barack Obama’s promise of “if you like your healthcare plan, you can keep your healthcare plan,” was his declaration that “people with pre-existing conditions shouldn’t be penalized.”
Yeah, well, that was then and this is now. People with serious pre-existing diseases, precisely those Obama said the “Affordable Care Act” would help, could find themselves paying for expensive drug treatments with no help from the healthcare exchanges.
Those with expensive diseases such as lupus or multiple sclerosis face something called a “closed drug formulary.” Dr. Scott Gottlieb of the American Enterprise Institute explains:
“If the medicine that you need isn’t on that list, it’s not covered at all. You have to pay completely out of pocket to get that medicine, and the money you spend doesn’t count against your deductible, and it doesn’t count against your out of pocket limits, so you’re basically on your own.”
But didn’t Obama pledge — multiple times — to help those with pre-existing conditions, a: get covered, and, b: control their cost of healthcare? Here’s the reality, according to Dr. Daniel Kantor, who treats MS patients and others with neurological conditions:
“So it could be that a MS patient could be expected to pay $62,000 just for one medication. That’s a possibility under the new ObamaCare going on right now.”
Moreover, Dr. Kantor worries that “this may drive more patients” to not buy their medicines, “which we know is dangerous,” he says. “We know MS can be a bad disease when you’re not treating it. When you’re treating it, for most people they handle it pretty well, but we know when you don’t treat (it), it’s the kind of disease where people end up in wheel chairs potentially.”
And so it continues. What began with the botched rollout of a website, continued with millions of health insurance cancellation notices, and will undoubtedly face a year when the other shoe continues to drop, we are in the midst of doing exactly what Nancy Pelosi infamously said before the bill became law: we are “finding out what’s in it” — and we don’t like it.
Dang... that kenyan commie lied again... who would have thunk it?
Since (almost) everyone seems to agree that you should still be able to buy “insurance” against sickness even if you are already sick (which is not insurance at all, of course), we might as well nationalize and get it over with.
“There is an exceptions process for non-formulary medications based on medical need. The physician has to make a case and justify the use. Then it is covered like a brand name.”
In industry when you want to appear to be cooperating but you don’t want something to happen you kill it by doing “the slow roll.” (Also, “killing it with yes” or “Yessing it to death.”) One method is to create difficult paperwork that you have no intention of processing. There was an article on FR yesterday about doctors quitting private practice and going to work for hospitals because of their increased paperwork. A doctor is going to see many more patients under the ACA. Just the standard paperwork is now tremendous. A nurse once told me my doctor had stopped writing pain medicine prescriptions because the DEA made him write a letter with each one and provide patient records. So his patients were in constant pain. (Yes, there was probably a problem as he left town with no notice.) But the point I his patients suffered as a direct result of DEA required paperwork. So, how many doctors simply won’t even mention medicine that will require them to give up their own time to justify?
Yeah, sure.
As a sideline, I run a clinic for people going overseas.
Usually, their malaria meds are not covered, unless I "make a case and justify the use".
This process of "making the case" takes between 30 and 120 minutes depending on the insurer, the day of the week, and the time of day.
If I had to do this once every six months, it would be an imposition. Twenty times a week, it is an impossibility.
Of course, the insurers blame me.
You and many others will become medical tourists. You’ll probably go to India.
Yes, and they even came up with a cute marketing slogan for it too - "job lock" - being locked into your job to keep the insurance. Pelosi mentioned it as recently as last week.
I don’t doubt your experiences requesting exceptions but I know that in two recent cases in the family (Fosamax => Prolia for my elderly mother) and (Effexor => Effexor XR) for me, getting the exception was no big deal. The Prolia is $$$$ as you know. In my case the nurse made the phone call and sent the FAX and I suspect the same of my mom’s clinic.
Besides, I was trying to point out to people that a closed formulary isn’t really as closed as the article makes it out to be.
Sorry I missed your comment earlier. Yes, the barriers to opiate treatment are really formidable, especially in a state like mine (WA), where the legislature has been gung-ho on this.
But I don’t see where Obamacare (”exchange”) policies are much different from older policies with respect to formulary exceptions.
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