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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsThe New Way Insurers Are Shifting Costs To The Sick
http://talkingpointsmemo.com/news/insurers-pay-more-drug-conditionsInsurers have long tried to steer their members away from more expensive brand name drugs, labeling them as "non-preferred" and charging higher co-payments. But according to an editorial published Wednesday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.
The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn't stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments "non-preferred," according to the editorial.
"It is sometimes argued that patients should have 'skin in the game' to motivate them to become more prudent consumers," the editorial says. "One must ask, however, what sort of consumer behavior is encouraged when all generic medicines for particular diseases are 'non-preferred' and subject to higher co-pays."
Derp.
Dustlawyer
(10,495 posts)The mail order pharmacies don't ship all of the meds ordered, send them regular mail, and when you try to order ahead so you don't run out the insurance companies say, "too soon!"
I travel a lot for work on short notice, I have been totally screwed!
truedelphi
(32,324 posts)are telling one person after another that "the computer is letting us know you are ordering this medication too soon."
I live in a rural area, and for elderly or sick people to have to travel a great distance the next day or the day after that, all to keep some computer in the sky happy, is really deplorable.
We must elect someone on our side.
Dustlawyer
(10,495 posts)Because I did no one locally will treat me so for the last 4 years I drive a 4 hour round trip once a month to pick up my prescription (one has to be in person), drive to the other side of Houston to fill it because local pharmacies won't fill a Houston prescription due to pill mills, and come home. Our system is screwed up!
jwirr
(39,215 posts)we try to order too soon. In fact my daughter has been on Medicaid for 55 years and it has been happening since then.
Edited to say that my daughter was on straight Medicaid.
I think many states actually have laws that the pharmacy cannot refill orders until most of them are used up.
ChiciB1
(15,435 posts)However my mail order experience is A+. Of course there's probably a good reason for this because my husband worked for a Union Company and our insurance has a drug policy included. I feel so very, very lucky at this point in time. When I decided to use the mail order I was unsure of how the experience would be, so I registered with their website to make sure there would be no mix ups.
To my surprise they have been very efficient and call us with reminders when we need refills in case we overlooked it. All I have to do is give them my birth date, zip code and my insurance ID # and they take it from there. If my script needs the doctor to approve a refill they call his office and set it up. On rare occasions I'm asked to call my doctor to solve a problem. And my medications are always shipped free.
I do think that Obama had to make some concessions with Big Pharma to get the ACA passed and we must be seeing that they're still getting their BIGGER share of the pie! This is unacceptable and I don't doubt they've found a way to keep padding their pockets!
I don't even think calling your Senator or Representative will be much help because of the massive obstruction movement to get rid of the program, small as it is.
My experience with belonging to a Union and being able to have a choice each year to stay with our current provider or change, has made me realize how fortunate we are. That's not to say I agree with how the health care system is run today because I know from statements I get how the money is spread around, and obviously it's skewed to benefit the rich even now.
It's so very important that Democrats vote, I fear the fight will get nastier if the Senate goes down. I have my issues with Obama and feel the ACA is only a very small step, but it's a start. So, so much more needs to be done and I worry all the time that Obama is being forced to sell out more and more. Plus, Obama's hands have been greased and concessions made that many of us find offensive.
THE GAME IS RIGGED... GREED ABOUNDS... "We The People Suffer!" I've been watching the PBS Series on The Roosevelt's and even though Franklin is at his core a politician with warts, at least he did see how the country suffered. I don't know how many are watching this, but it's an eye opener and certain facts about FDR show a different side of him. Still, he DID care.
We can only try to push back, but personally I think we're at a point in history where nothing is going to wake up enough people until the wheels come off. IMO that day is coming because even voting may only help a little. The districts are drawn to re-elect the same people and the glut of money going to the Oligarchs is being used for LEVERAGE in their favor!
SharonAnn
(13,776 posts)They should be required to keep the same doctors and the same tiers for the one year contract period. Otherwise, we're locked in and they aren't. Perfect setup for a scam. surprise, surprise!
dilby
(2,273 posts)Make it mandatory to have insurance and insurance companies will suck you dry. We need single payer and we need it now.
truedelphi
(32,324 posts)Enthusiast
(50,983 posts)jeff47
(26,549 posts)The ACA moves the battle for single-payer to the states. So start working on your state representatives.
Louisiana1976
(3,962 posts)unblock
(52,256 posts)$80.
that's right, double the "maximum" co-pay.
how? because they decided that 6 doses was enough (hah!) per month and if I need more, i can get a second box of 6 doses -- for a second co-pay.
other meds your doctor just specifies the count and strength and if the doctor says it's a 30-day supply, then that's that. in this case, zomig (along with other migraine-fighting triptans) are expensive, so my insurer finds it profitable to screw me over.
frankly, i think they're missing an opportunity here. why not just make the co-pay $40 for each individual dose? and why do it only for expensive meds?
NYC_SKP
(68,644 posts)I'm fighting with Athem over a $27,500 charge to fly me to Stanford for treatment of an aneurism.
They hired a third party MD who tried to justify denial of benefits.
In my case, the letter I got Monday reads, "You fell and hit your head" and goes on to suggest I should have driven myself over or taken a land ambulance.
So, of course, I have to fight them and I think I'll prevail, but they are banking on the majority who don't know what to do, how to respond, or even realize that they can file a grievance and get letters of support.
Fuckers.
OBTW, my favorite reply from some (not all) anthem reps: "Yeah, but look at all the costs we DID cover!" OK, fine, you did your job, now do the rest of it.
My costs were over $600,000, and that's why I have insurance.
KamaAina
(78,249 posts)truedelphi
(32,324 posts)Idea of forcing people to have insurance, and yet somehow avoiding making it Universal Single Payer HC, was a total sellout?
People are still having to waste days and weeks of their lives arguing with insurers, and pharmacists. People will still end up being denied treatment, being given lousy and even deadly treatment, and going through medical bankruptcies.
And in states that have the "Exchange" often the whole conncept is fraudulent. My spouse just heard from a friend in Marin, who chose his insurer after doing his homework diligently. He visited the Big Insurers websites, and then chose the insurer that had the names and photos of the doctors whom he needed.
Only after he was injured did he find out that the Big Insurers can simply put up whatever they want to on their websites. In his case, not a single one of the doctors he relied on really was with the Big Insurer he had chosen. But their names, photos and bios were up on the website!
NYC_SKP
(68,644 posts)My monthly savings bought me a dream retirement home with, ocean view,
Thanks Obama!
Maybe you experience was different....
BrotherIvan
(9,126 posts)My insurance has tried to cancel me every month since switching to an ACA policy. EVERY month I'm on the phone for a minimum of two hours because they can't figure out the automatic deduction. They also have a second policy tacked on where I pay "juvenile dental", some kind of fee that puts into a pot for others. Fine. But then they keep claiming that has not been paid and try to cancel my whole policy for that.
I haven't used it and frankly and loathe to because I know they will screw me royally and deny everything. It's junk insurance and completely useless.
These companies are some of the worst blood suckers (literally) in existence.
aggiesal
(8,919 posts)where at least one of the drugs for a particular illness has to be in the
preferred list.
Bastards.
Doctor_J
(36,392 posts)Not even going to comment. The law's a debacle, and as soon as it's in the rear view mirror, the better off we'll be
Enthusiast
(50,983 posts)Dont call me Shirley
(10,998 posts)Jackpine Radical
(45,274 posts)under private control, the focus is on making profits rather than meeting human needs, and such abuses are unavoidable. It's just the way captialism, partiularly late-stage capitalism works.
moonbeam23
(312 posts)(we know the answer)
WTF "skin in the game"??? Do they think people will inject extra insulin or pop more hypertension pills or start overdosing on pain pills just because it's cheaper....
Get rid of these bastards once and for all...single payer now!
RedSpartan
(1,693 posts)Gawd bless capitalism.
Nye Bevan
(25,406 posts)It seems that nobody covers it and full price is an absolute fortune. I don't understand how anyone can afford to use it anymore.
Spitfire of ATJ
(32,723 posts)Cleita
(75,480 posts)the insurance companies, whose function is a parasitical one on the health care sector of the economy. They aren't needed. But we all knew that as we watched Max Baucus and Co give away the store.
quadrature
(2,049 posts)as long as someone else is paying
KamaAina
(78,249 posts)Explain, please. And how is this relevant to the OP, which is about even the least expensive drugs being blacklisted by the insurance co's?
quadrature
(2,049 posts)that costs a dollar a day,
but requires it be taken twice daily.
and there is a btandname drug that
costs ten times as much, but is
time released, and need be taken only once a day.
some people will choose the latter,
as long as someone else is paying.
KamaAina
(78,249 posts)So the insured* are screwn.
quadrature
(2,049 posts)to answer properly,
I would need to know all the
alternatives, which is beyond
the scope of the article.
lets just say that when a Drug Company
complains that an Insurance Company
is not paying for the super-priced pills,
I am skeptical