Skip to comments.Remember Obama Saying People With Pre-Existing Conditions Shouldn't Pay More? Yeah, Well...
Posted on 02/16/2014 8:59:13 PM PST by 2ndDivisionVet
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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 dont 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 wont even mention medicine that will require them to give up their own time to justify?
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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