Prescription medication


medicationWhat does Obamacare mean for prescription medication?

This week we saw the deadline day for the Obamacare website. President Obama said “Today is the day for the website so check it out” While the Whitehouse said that “the website is working well for the vast majority of users.”The official name of Obamacare is the Affordable Care Act –and it is meant to allow access to cheaper prescription medications as well as reform the American health system.

Prescription drugs are now one of 10 essential benefits that an insurance policy is now required to offer. This is mandated by the US government but it may not necessarily be good news. So now you have mandated prescription medication coverage – but not for all drugs.

medication-1The mandated prescription medication coverage is for one drug in each category or class in the pharmacopeia (The official list of medications in the US). As an example – if you suffer from high blood pressure and have been taking Altace for it – but now your insurance does not cover Altace as the prescription medication of choice, you will now have to pay out of pocket for something that used to be covered. There are other ways Obamacare impacts prescription medication. The amount of copayment for a medication can vary widely between insurance plans and insuring companies. You should also check if there is a special list of prescription drugs that your plan will cover. This is especially important if you have a preexisting condition and you are stable on a certain medicine.

Beware that there is often a Step requirement for a prescription drug. This means that for example if you are taking Nexium for GERD, your insurance may only cover once your doctor has exhausted other medications and they have failed. This Step requirement will require time and frustration and may prevent you from continuing to receive a medication you know works.

medication-3Doctors can apply for an exception for medical need so that your insurer will cover it. It has been requested that insurance companies respond to these exception requests within 3 days. GOOD LUCK!

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So we have seen that Obamacare is toted out as the saviour of the American medical system, when in fact it is clear from the small example given here that it is going to be a long and windy road until you can both understand the new System and navigate it well enough to help you save money and help protect your basic health rights.