ObamaCare: Threatening Prescription Drug Coverage, Too

Posted: Dec 10, 2013 8:49 AM

If you like your prescription medicine and want to keep your prescription medicine, you may have a leetle bit of a problem under ObamaCare. The Washington Post helpfully explains.

Rather than simply having the option of picking a plan that offers prescription drug coverage for an extra cost, now prescription drug coverage is one of the "10 essential benefits" (sort of like the maternity coverage for the geriatric set, I guess) that every health insurance policy will now cover, courtesy of a US government mandate by the US government.

But that doesn't mean you will necessarily get what you want -- or need. Yes, there's prescription drug coverage -- but not for all drugs. Just for "at least one drug in every category and class in the U.S. Pharmacopeia, the official list of approved medicines." It's a little like every plan being required to cover obstetric care . . . just not necessarily with the doctor you have and like -- or the hospital that you want to use.

As the Post notes, it's best to be careful when you're shopping for a new plan:

Your co-pay or co-insurance — the amount that you’re responsible for — could vary enormously. Some plans may ask you to pay $30 for a medicine while others could charge you $1,000 for the exact same thing, so be sure to check the name of the drug and the specific dosage you need. Don’t forget to find out whether the plan covers the number of monthly doses needed. If you are taking medication for a chronic condition or something that has a high retail price, you may want to ask whether your plan maintains a separate list of specialty pharmaceuticals that are covered.

Sound complicated? You're only getting started:

You should pay attention to a few other things, including whether the drug requires authorization under certain plans. This could be time-consuming and means you’re not guaranteed access to the medication. Also, you should find out whether there is any “step” requirement — meaning that your doctor may have to try a different drug first and provide documentation that it failed before the insurer will cover another medicine.

So if you suffer from migraines, for example, you may have to go without the medicine that you know actually works -- to give your doctor time to document that you were sick as a dog with all the other available options.

Got a medicine you need, but thanks to ObamaCare, it's not on the approved list? Don't worry! The Post chirps:

Your doctor can ask for an exception for medical need so that the insurer will cover it. The Centers for Medicare and Medicaid Services is encouraging insurers to respond to such requests within three days. If your request is denied, you can go through your state’s appeals process, which usually is handled by insurance regulators.

I bet that's a speedy, pleasant process! Finally, if all else fails, the Post concedes:

If you still can’t get coverage and need to take the drug, you’ll have to bear the full cost out of pocket, as it won’t count toward your deductible or your co-insurance maximum.

Thanks, ObamaCare. Now it's not just health insurance and doctors that Americans may lose -- it's their prescription drugs, too. Way to go.

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