Skip to comments.Prescription Drug Coverage Under Obamacare óDo You Need to Worry?
Posted on 04/22/2014 9:55:34 AM PDT by Las Vegas Dave
In 2013 some Americans will start choosing health insurance plans offered by the new state-run health insurance exchanges. Designed to lower prices and increase competition, the exchanges will surely help millions of people access affordable care. However, health insurance plans often do not adequately cover prescription medications, and we are eager to follow the effectiveness of the exchanges as applied to prescription drug pricing.
While we hope (and believe) that increased coverage will enable more Americans to take needed medications, we believe that many will not benefit from the increased coverage. The Obama administrations loose guidelines pertaining to prescription drugs and essential health benefits mandate that they require only one drug per class in other words one statin (to treat high cholesterol), one proton pump inhibitors (to treat GERD), one inhaled steroid (to treat asthma), and so on, must be covered.
For many this will not be a problem. If there is only one prescription you plan on taking, you should be able to find a plan that covers it. If, however, you are taking multiple medications, things could get a bit hairy. Just because two drugs are in the same class doesnt mean they work with the same efficacy for a given person. For example, atorvastatin (generic Lipitor) may work better for cholesterol treatment than simvastatin (generic Zocor) for one person, and vice versa for another. Imagine how difficult it would be to find an insurance plan that covers all your drugs if you are on three or four medications!
Some states plan to address this potential problem by requiring that plans offer more extensive drug coverage. As of October, 2012, an analysis of eight benchmark plans shows that they cover about 62% of drugs available in different classes.
While the health insurance exchanges are meant to provide a competitive marketplace that lowers costs, it isnt as simple as just choosing a plan that covers the most drugs. You need to make sure it covers your drugs (in addition to other specific health benefits). We hope that the insurance exchanges will help end Americas $317 billion prescription non-adherence problem, but we fear that the pharmacy coverage under Obamacare wont be nearly enough.
Freepers note, your Rx prices are going up in costs..
< snip >
The pervasive use of generic over brand-name medications was anticipated to be a money-saver, but recently prices are soaring, even up 6,000 percent for some common drugs that were once fairly low-cost.
As National Journal reports, pharmacists are perplexed about the huge price hikes in many drugs and are asking Congress to hold a hearing to look into the matter.
Generic drugs such as Pravastatin, which treats high cholesterol, and the antibiotic Doxycycline spiked upwards of 1,000 percent in 2013, according to a survey by the National Community Pharmacists Association.
According to the survey, 77 percent of pharmacists said they experienced 26 or more instances of a large increase in the acquisition price of a generic drug within the last six months of 2013.
The survey found an additional 84 percent of pharmacists said price fluctuations prevented them from providing care and remaining in business due to the fact that filling prescriptions resulted in losses when some patients refused their prescriptions because of costs.
In other words, the IPAB board is going to offer a convenient one-stop shopping center for Big Pharma corruption.
I think the writer meant 'allow'
And that's the problem, Not everyone can take the same drug for the same condition. Add in multiple prescriptions and you have issues with the drugs interacting with one another. Also for those on longterm prescriptions there are those that develop issues and the Doctor changes the prescription.
So in the wisdom of the non-doctors who run ObamaCare, these details were not and will not be taken into consideration!
In November we received a letter from our insurance company telling us that our two-year-old’s asthma preventer is subject to “quantity limitations” as specified by the ACA. Don’t worry, she can get “free” birth control pills and unlimited access to Plan B.
Since I no longer have health insurance, I won’t worry one little bit about this. Frankly, there’s a LOT I don’t worry about any more. It was oddly freeing.
When the Lord wants me, He’ll take me. And He’ll provide until then.
Ran into a gal last night who sells Medicare Insurance.
Didn’t know there was such a thing.
Anyway, she swears ObamaCare® resolves the New”Don’t Hole”. for Medicare subscribers and will eventually cover all medication universally.
Thus will lower costs for almost everyone
I think she is wishful thinking myself.
Hasn't been fun watching my country die. Won't mind it AT ALL when it is checkout time.
Hasn’t been fun watching my country die. Won’t mind it AT ALL when it is checkout time.
That said, my place in central KY can become a 32 acre “compound” if necessary.
And if you need medicine, which will be limited under ObamaCare®, you can always take a vacation to another country and obtain the medicines you require and the amount necessary.
The necessary shouldn’t be a government definition or bureaucratic standard
I recently change blood pressure medicine from the I had taken for 14 years.
It put me in the hospital a week after starting the New med.
3 Emergency doctors, a friend who is a doctor and my personal physician recommended returning to the original med.
I waited a week and returned to my original prescription.
The “one drug per class” stuff pertained to Medicare — and was repealed recently.
My drug formulary did not change one iota. It is exactly the same before and after Obamacare (Express Scripts), except for new generic drugs being added as they came off patent.
Shut up. LOL
You are way too young to even ponder death.
Party on....with his highness HG....
She is correct that the donut hole is, by law, gradually going away. She is incorrect that all medication will be covered. One has to buy a drug plan for Medicare and those companies keep or change which drugs are covered every year.
Also, just because there is a law gradually eliminating the donut hole, that was before Obama, so I expect that law to go away by either congress but most likely by executive order and we seniors will be limited to ——aspirin over the counter, plus given a marijuana plant. What the government gives, the government can take away. Seniors will be doing good if we aren't turned into soylent green by a mandatory age.
your Rx prices are going up in costs..”
No kidding. Had eye surgery last month which resulted in having to fill two prescriptions. Had I had false teeth when I went to pay they would surely have popped right out.
Real shock to those of us who don’t normally take meds. Fortunately I was able to find some coupons on line and a pharmacy that would take them which saved me almost half of the $369.
I had high blood pressure (~164/102) for quite a while (years). Solution (gleaned from the internet): I stopped drinking, completely. In two months it was dead center normal.
I went to the doctore for a broken toe, though I don’t remember breaking it. He took x-rays and said he didn’t know what was wrong (no break) but to be careful with it. I got home and, after ten minutes on the internet realized I had gout and black cherry juice would fix it. It did.
I now get a flare up every 9 months or so. I take black cherry capsules and it’s gone the next day. A three year supply of these little marvels was $21.
And heart disease and cancer? Look up the gerson treatment. An acquaintence was diagnosed with stage 4 breast cancer. Her only treatment, and against her doctors wishes, was the gerson treatment. She’s been cancer free over two years now.
We grow our own food as much as possible and watch our diets and exercise. I need doctors for stuff like broken bones. And that can usually be fixed for less than a single months health insurance premium, with a deductible so high it wouldn’t cover it anyway.
As I said, very freeing.
Highly over rated.
I party with that guy every weekend and it gets old.
I order this generic from Jan Drugs in Canada. I order the 300 mg & split the tablet to 150 mg. My total cost for 100 tablets (200 day supply) cost me $119.
When I partied with HG, I became very self-conscious. I realized I was fat, and unattractive, and greasy, because HG makes Brad Pitt envious. DO NOT PARTY WITH HG, you will never think of yourself the same way again.
Take somebody we all hate with you when you go!
Another reason I’m grateful for having been brought in a family that believes drug-free and natural is a good thing...
It is liberating, indeed-I’m healthy and happy, too not overweight, and do physical work. The warnings that come with meds say “this medication can cause death”-if something is more harmful than the condition it treats, why would any sane person use it? But then, there is all that lawsuit money available...
There are many (un) intended consequences under Obama care that will start to bubble through the surface.
My Spouse has had 4 Back operations, has titanium rods from her neck down to her tailbone and rods going into her hips.
Her doctor had tried all different medicines, including morphine patches, to help with her incredible pain. # years ago, she stumbled on a medication that has pain relief as a side effect. It worked wonders.
This month we tried to fill her new prescription, only to be told that the medication was refused, because of the new Obama care rules.
I spoke with the pharmacy and was told that our predicament is not isolated. Many prescriptions are affected and many customers are starting to be upset even cursing at the stores. Of course, it is not their fault. It is the ACA that is causing the problem.
Just some food for thought.................
We can pay for the prescription on our own. $ 500.00 PER month. We had it filled for 3 years without a problem. So much for your Doctor to decide what is best for you. I guess beaurocrats know better?
The warnings that come with meds say this medication can cause death”
...unlike the “accepted” (and expensive) treatments commonly used in the AMA approved hospitals. :-P
Funniest guys on FR.
Completely unconsummed or concerned with themselves and okay just as you are.
Party on Garth....
Particularly bitter medicine given the fact we are on the cusp of the genomic revolution that will allow doctors to customize drug therapies for patients.
Dangerous, like standard chemotherapy that gradually kills vital organs so that something other than cancer kills the person. The standard burn-and-poison “therapy” isn’t about getting cured, it is about treating symptoms. If you are cured, the money to big pharma goes away-a friend of mine had to get into a research program to get the new genetic therapy for cancer that is individually tailored with diet and mind/body therapy, mild side effects, etc...
a friend of mine had to get into a research program to get the new genetic therapy for cancer that is individually tailored with diet and mind/body therapy, mild side effects, etc...
Thing is, it really works. We had heard stories, but when it was verified through someone we actually know, we started paying attention. At the very least, we purchased a masticating juicer and changed our diets. We’re taking our half acre garden a LOT more seriously this year as well.
It is already being tried-and not well received because it actually seems to work-even if the treatment is expensive, money to pharma dries up if people are cured-can’t have that-my friend had to go through a research program to get it...
It is very similar-the drug/substance is designed only for that person-what has been shown to kill cells from their tumor while not killing the healthy cells around it. Each person is different-what helps one person might kill another outright, so it can’t be bottled, labeled chemo-XXX and used on just anyone. I suspect that one-size thing is what is wrong with drugs anyway-no wonder you take them at your own risk...
I take aspirin. That’s it.
I have Advil for dire emergencies, but haven’t needed it in awhile-vitamins and supplements are all I take otherwise.
I stopped eating/serving any processed items-including bleached flour and rice, processed sugar, and started baking my own whole-grain bread-when my kid was a baby, and I’ve never missed the packaged stuff-I still weigh the same as I did at 17, too-108-110. Thankfully, there is fresh-today fruit, eggs and meat to be bought or bartered here, and I do grow many of my veggies and most of my herbs.
Heh, I’ve discovered a plethora of Amish markets where I live. The quantity and types of natural foods available at many of them is simply amazing.
I confess my wife introduced me to Advil a few years ago too. I’ve always called er “Eve 2.0”. I guess with the first one it was the apple. With version 2.0 it’s Advil.
I’m glad to hear your friend is benefitting from this. An old friend is a leading figure in the genomics field. Really exciting stuff.
No Amish here, but plenty of old hippies who are rednecks-or maybe it is rednecks who are hippies-either way, most people with the room for it have livestock-I intend to soon, as well-and going in with a neighbor to buy 1/4 to 1/2 of a cow or hog from another neighbor who is going to slaughter one is common-the meat is fresh, wrapped at the locker plant and free of hormones and other drugs-doesn’t get much healthier than that.