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Getbig Main Boards => Politics and Political Issues Board => Topic started by: dario73 on December 10, 2013, 05:32:17 AM
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No, You Can't Keep Your Drugs Either Under Obamacare
http://www.forbes.com/sites/scottgottlieb/2013/12/09/no-you-cant-keep-your-drugs-either-under-obamacare/
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.
There are two reasons why. The first has to do with the higher out of pocket costs patients will face. The second issue may be even more significant.
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).
People whose annual income is at or below 250% of the Federal Poverty Level will qualify for cost-sharing reductions. (That comes out to families of four earning less than about $60,000, or individuals earning less than $30,000). But people qualify for these cost-sharing subsidies only if they enroll in a higher cost, “silver” Obamacare plan.
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.
If you buy the highest cost platinum plan, the out of pocket costs drop to $792 a month. But you’re probably better off with the cheaper bronze plan anyway.
Since you’re going to hit your out of pocket cap regardless of your plan, you might as well save money on the premium (which doesn’t count against your deductible or out of pocket limits) and race to the $12,700 spending cap as quickly as your family can.
After all, the provider networks (and formularies) used by low cost “bronze” and high cost “platinum” plans are often the same. The only thing that varies between different “metal” plans is typically the co-pay structure. Why pay higher premiums just to lower your co-pays when you’re going to hit the out of pocket caps anyway.
By purchasing a costlier, gold or platinum plan, you typically can’t “buy up” to a higher benefit. What you’re really doing is just prepaying the cost sharing.
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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 response to the drug formulary issues, and the potential for important drugs to remain completely uncovered, staff at the Centers for Medicare and Medicaid Services is arguing that patients will have the option to appeal formulary decisions — to try and compel a health plan to cover a given drug.
But this appeals process can take months. And there is no sure chance of winning.
If a drug costs tens of thousands of dollars a year, how many patients will be able to foot that bill out of pocket until they win an appeal. Or take the chance that they could lose the appeal, and be stuck with the full cost of the drug?
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HAHAAHAHAHAHA all who voted for Obama deserve their fate!
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There are some things we know about these formularies.
Under the law, the Obamacare plans benchmarked their drug formularies off of one of the health plans already operating in each state.
In selecting this benchmark, they could have to select from one of four options:
They could choose from: 1) One of the three largest small group plans in the state by enrollment; 2) one of the three largest state employee health plans by enrollment; 3) one of the three largest federal employee health plan options by enrollment; or 4) the largest HMO plan offered in the state’s commercial market by enrollment.
Because there’s a wide variation in the breadth of the drug formularies maintained by these four options, there is also wide variation in the Obamcare plans.
The formulary you’ll get depends most of all on which state you live in (and which benchmark was chosen by the state regulators).
It also appears that the final regulation on all this, issued by the Department of Health and Human Services, gave states some latitude to nix drugs that might otherwise be listed on the benchmark formularies they selected. That regulatory wiggle room seems to undermine the whole idea of having a benchmark plan.
So can you find a good drug plan in Obamacare?
It’s difficult.
But there is a lot of variability.
For example, when it comes to costly, molecularly targeted cancer drugs, some benchmark plans cover 11 drugs, but other plans cover as few as seven. I found one plan in North Carolina that doesn’t cover Actonel for osteoporosis, Aubagio for multiple sclerosis, or Xeljanz for severe rheumatoid arthritis, among other “non formulary” drugs.
In California, a state that Obamacare’s architects are holding up as the model of success, some of the major exchange players—including Anthem, Blue Shield of California and Health Net—have posted their exchange formularies on their websites. Unfortunately, they’re not easy to find — and incomplete.
As another excellent analysis finds, a lack of standardization and on-line tools makes it hard for consumers to compare between plans.
Some of the published lists do not show all of the covered drugs. For instance in California, Blue Shield’s document states that only the most commonly prescribed drugs are shown in its published formulary. Anthem’s published list is also not comprehensive.
Some analysts have tried to look across the plans, but comparisons are as hard for experts to make as they are for consumers.
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One study by Avalere Health of 22 carriers in six states looked at the benchmark plans that the Obamacare plans would be tied to. It found that the numbers of drugs listed as available on formularies ranged from about 480 to nearly 1,110.
Even if your drug makes it onto the Obamcare plan’s formulary, getting access to a medicine can still be a costly affair for patients.
In the same study, researchers found that 90% of the lowest-cost bronze plans require patients to pay 40% (on average) for drugs in tiers 3 and 4, compared with 29% co-pays in current commercial plans. Most of the Obamacare silver plans also require patients to pay 40% for the highest-tier drugs.
Drug makers with big portfolios of specialty and primary care drugs, for their part, will have to fight on a state-by-state level to make sure that the benchmark formularies that state regulators adopt allow open access to their medicines.
There’s word that companies like Pfizer [NYSE:PFE] and Merck [NYSE:MRK] have been beefing up their state operations for just this purpose. They are late to the challenge.
Drug makers were focused on a condition that health plans must have more than one drug per class. But these firms may have been focused on the wrong proviso.
Many formularies are shaping up to be very restrictive even while meeting that minimum standard. The biggest challenge will be in getting new drugs onto existing formularies. The process is likely to be long, slow, and austere.
Health plans are cheapening their drug formularies – just like they cheapened their networks of doctors. That’s how they’re paying for the benefits that President Obama promised,everything from free contraception to a leveling of premiums between older (and typically costlier) beneficiaries, and younger consumers
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But the need to fund these promises will put drug formularies in play for the long run. New medicines will remain off formularies, or make it on after long delays. Patients will find that costlier specialty drugs are simply not covered.
Like a lot other parts of Obamacare, uncertainty around drug costs and coverage is becoming another one of the scheme’s unpleasant surprises.
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HAHAAHAHAHAHA all who voted for Obama deserve their fate!
The issue is these retards seem intent on taking everyone else's insurance down with them
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Liberals are communists
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Liberals are communists
And stupid, VERY STUPID.
You know what is worse than crapcare?
FOX paying hush money!!! Oh, the humanity!!!
I wonder how many cancer patients will be denied coverage, doctors and medications by FOX's actions.
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Yes.
Just like I expected.
Absolute silence from the idiots who voted for this.
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Yes.
Just like I expected.
Absolute silence from the idiots who voted for this.
But FAUX News!!!!!
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This is a serious, serious disaster, a fuckover of millions to throw bones to the dem base.
This should be a total killer for the democratic party.
If the dems still win elections after this, it means we have reached the 'fundamental turning point' in america where the sheer numbers of dregs dictate elections and policy, and america will begin a steeper, irreversible decline on all fronts.
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Yes.
Just like I expected.
Absolute silence from the idiots who voted for this.
Well, fuck me, that means we can expect more OCD riddled posts by 33 without his meds.
Where is ja when you need him? someone call ja.
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This is a serious, serious disaster, a fuckover of millions to throw bones to the dem base.
This should be a total killer for the democratic party.
If the dems still win elections after this, it means we have reached the 'fundamental turning point' in america where the sheer numbers of dregs dictate elections and policy, and america will begin a steeper, irreversible decline on all fronts.
GOP has to present to the nation their own health insurance plan or at least a plan to help those other 15% that are not insured. We know that they have proposed several ideas that have been ignored by the dums.
But, republicans have to come to a concensus and put all those ideas into one plan that they can present to the nation. They have to clearly explain them over and over again until people can associate those ideas with the GOP. Right now, a lot of people don't know or even understand those GOP ideas.
I still haven't seen that effort from the GOP. I mean a constant promotion of those ideas. They need to do that and not just rely on crapcare imploding on itself. They should not fix crapcare but they need to present an alternative.
If they do that, they can win. If they don't, then we need another party.
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GOP has to present to the nation their own health insurance plan or at least a plan to help those other 15% that are not insured. We know that they have proposed several ideas that have been ignored by the dums.
But, republicans have to come to a concensus and put all those ideas into one plan that they can present to the nation. They have to clearly explain them over and over again until people can associate those ideas with the GOP. Right now, a lot of people don't know or even understand those GOP ideas.
I still haven't seen that effort from the GOP. I mean a constant promotion of those ideas. They need to do that and not just rely on crapcare imploding on itself. They should not fix crapcare but they need to present an alternative.
If they do that, they can win. If they don't, then we need another party.
Very true. Problem is is there is a civil war going on right now, with the true conservatives trying to rid the party of the Vichy republican dem collaborators who have been fighting the conservatives and the base instead of fighting the dems. This makes is hard for them to unify and get a clear message out about alternatives. Many are wanting a 3rd party, but in reality all know this will just hand all elections to the dems, who will get a unified vote. Unfortunately the only way is to stay within the party and take over control in the elections next year. If the conservatives can't take control of the party, the country is fucked.
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I can safely assume that libtards are fine with people having a more difficult time paying for their medications, IF THOSE MEDICATIONS ARE EVEN COVERED.
Duly noted.
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I can safely assume that libtards are fine with people having a more difficult time paying for their medications, IF THOSE MEDICATIONS ARE EVEN COVERED.
Duly noted.
Everything you say is true, 50# of the time.
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Everything you say is true, 50# of the time.
Which is still better than you OR ANY LIBTARD.
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Which is still better than you OR ANY LIBTARD.
Read the first few lines of your post, the word MAY is key. You have a habit of jumping all over things that haven't occurred. Why you don't see the libtards is that most of the ones on this site are pretty rational people, and you are not. Hence engaging you is like tbombz wearing a condom, pointless.
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Read the first few lines of your post, the word MAY is key. You have a habit of jumping all over things that haven't occurred.
This is the same asinine logic you libtards use to demean conservatives when they ARGUED that people would not keep their coverage, nor their doctors, nor HOSPITALS.
EVERYTHING WE SAID ABOUT THIS CRAP LEGISLATION HAS COME TRUE.
AND SO WILL IT BE FOR THE COST OF MEDICATIONS!!
I can't help libtards with their lack of vision. Libtards are not RATIONAL. THEY ARE EMOTIONAL.
If they were rational they would not hold the belief that government can solve every problem, nor that everyone has a right to be taken care of by government. They wouldn't believe that it is correct to punish success, to steal from others by redistributing wealth and giving it to leeches. Where is choice? I thought libtards were big on "choice". I guess they preach choice it's only when it benefits their twisted view of society.
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Read the first few lines of your post, the word MAY is key. You have a habit of jumping all over things that haven't occurred. Why you don't see the libtards is that most of the ones on this site are pretty rational people, and you are not. Hence engaging you is like tbombz wearing a condom, pointless.
Yes, "may" now means "won't."
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Yes, "may" now means "won't."
No it means exactly what it means. conjecture nothing more.
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This is the same asinine logic you libtards use to demean conservatives when they ARGUED that people would not keep their coverage, nor their doctors, nor HOSPITALS.
EVERYTHING WE SAID ABOUT THIS CRAP LEGISLATION HAS COME TRUE.
AND SO WILL IT BE FOR THE COST OF MEDICATIONS!!
I can't help libtards with their lack of vision. Libtards are not RATIONAL. THEY ARE EMOTIONAL.
If they were rational they would not hold the belief that government can solve every problem, nor that everyone has a right to be taken care of by government. They wouldn't believe that it is correct to punish success, to steal from others by redistributing wealth and giving it to leeches. Where is choice? I thought libtards were big on "choice". I guess they preach choice it's only when it benefits their twisted view of society.
Haha neco = owned.
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GOP has to present to the nation their own health insurance plan or at least a plan to help those other 15% that are not insured. We know that they have proposed several ideas that have been ignored by the dums.
But, republicans have to come to a concensus and put all those ideas into one plan that they can present to the nation. They have to clearly explain them over and over again until people can associate those ideas with the GOP. Right now, a lot of people don't know or even understand those GOP ideas.
I still haven't seen that effort from the GOP. I mean a constant promotion of those ideas. They need to do that and not just rely on crapcare imploding on itself. They should not fix crapcare but they need to present an alternative.
If they do that, they can win. If they don't, then we need another party.
+1
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Haha neco = owned.
except over 1 million have signed up for no meds, a new doctor and higher costs.
Half of these stories aren't even true, you have idiots on fox making shit up, bringing out bleeding hearts who were proven fraudulant and yet you go on and on.
LANDSLIDE!!!!!!!
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except over 1 million have signed up for no meds, a new doctor and higher costs.
Half of these stories aren't even true, you have idiots on fox making shit up, bringing out bleeding hearts who were proven fraudulant and yet you go on and on.
LANDSLIDE!!!!!!!
Lmao..really??
and I definitely never called 'landslide', I knew romney didn't have a chance.
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Lmao..really??
and I definitely never called 'landslide', I knew romney didn't have a chance.
You son of a bitch.
Ya really, all of um are made up, the whole lot. I really need a gimmick account or two but since I mod I have to change characters often.
Romney in a landslide.
This isn't you?
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COME ON, KILL MEE, IM RIGHT HEEER, COME AAAHN, DO IT!!!
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except over 1 million have signed up for no meds, a new doctor and higher costs.
Half of these stories aren't even true, you have idiots on fox making shit up, bringing out bleeding hearts who were proven fraudulant and yet you go on and on.
LANDSLIDE!!!!!!!
Over 800,000 is for MEDICAID. The sickest of the sick, older individuals. Of course they are going to sign up.
But, how many are PRIVATE INSURANCE? About 365K and those are people that haven't even paid for it. That is a lot less than the 5 million that lost their private coverage.
No one said people were not going to sign up. THEY HAVE TO SINCE IT'S THE LAW and if they don't they get fined. Or is it taxed?
But so far, THEY ARE WAY OFF the 7 MILLION they predicted by January 2014.
http://money.cnn.com/2013/12/11/news/economy/obamacare-exchanges/
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/11/since-october-1-2-million-have-gained-obamacare-coverage/
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Over 800,000 is for MEDICAID. The sickest of the sick, older individuals. Of course they are going to sign up.
But, how many are PRIVATE INSURANCE? About 365K and those are people that haven't even paid for it. That is a lot less than the 5 million that lost their private coverage.
No one said people were not going to sign up. THEY HAVE TO SINCE IT'S THE LAW and if they don't they get fined. Or is it taxed?
But so far, THEY ARE WAY OFF the 7 MILLION they predicted by January 2014.
http://money.cnn.com/2013/12/11/news/economy/obamacare-exchanges/
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/11/since-october-1-2-million-have-gained-obamacare-coverage/
It's a fine, but the fine includes health insurance, the fine is a loss of money if an insurance plan was fully utilized, that's privately, businesses are a bit different, but again very few are effected in any meaningful way and a large subset of the poor uninsured won't die or go broke because of the flu. Also, they are off their prediction, no kidding, most red states didn't set up an exchange, then site problems etc. those are very large factors, one I think you have to look deeper into to understand.