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Obama-Care Will Not Cover Some Prescriptions

From Forbes:

No, You Can’t Keep Your Drugs Either Under Obamacare

By Scott Gottlieb | December 9, 2013

The President famously promised that you could keep your health plan and doctor. For many people, both of those pledges are turning out to be false. And now, you might not be able to keep your medicine, either…

Simply put, many drugs may not be covered at all, and the costs patients incur by buying them with cash won’t count against out of pocket caps. This has repercussions for drug makers with big portfolios of specialty and primary care drugs (more on that later). But most of all, it has implications for patients.

Drugs on your health plan’s formulary will typically have fixed co-pays. These costs usually count toward your deductible and the out of pocket and lifetime limits on the total amount of money that your health plan can ask you to spend.

As the Wall Street Journal recently reported, these co-pays can already be substantial, pushing people quickly to their annual out-of-pocket limits — $6,350 for individuals and $12,700 for families (after which insurers pay the full tab)…

Take, for example, the drug Copaxone for multiple sclerosis. Someone on a bronze plan would be responsible for paying about 40% of the drug’s costs out of pocket, on average. That comes out to about $1,980 a month… But at least — in this model case — the drug Copaxone was partially covered under the Obamacare plan’s formulary. Consider an even bigger problem lurking inside the law.

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

If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual)…

In other words, under Obama-Care some drugs will not be covered. So you will have to pay for them entirely ‘out of pocket.’ And that money will not count as part of your ‘out of pocket’ cap.

So if you need a particular drug that Obama-Care doesn’t cover, you could go broke.

The biggest problem in all of this is that consumers will have a very hard time figuring out where they stand. In many cases, the health plans being offered in the Obamacare exchanges don’t make information about their drug formularies readily available. In some cases, it doesn’t seem to be published anywhere.

The government was supposed to mandate that plans made this information easily accessible. But in many cases, that never happened.

In other words, the drugs that Obama-Care plans will cover are not listed on the exchange websites. So people signing up don’t know what the prescriptions they might need will be covered or not.

This article was posted by Steve Gilbert on Tuesday, December 10th, 2013. Comments are currently closed.

2 Responses to “Obama-Care Will Not Cover Some Prescriptions”

  1. heykev

    So everything about ObamaCare is a lie.

    Which for this President is about right.

  2. The Great Winnowing begins ..

    (remember the Kulaks)




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