This is grossly misleading.
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. Same as it’s always been.
“This is grossly misleading.”
And... the buzzing of the bees and the cigarette trees and the soda water fountain. The lemon-aid springs where the blue birds sing on the big rock candy mountain.
“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.