Surprised? You Can't Keep Your Medication, Either: More Obamacare Issues Reveals...

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You Really Shoudn't Be....You Can't Keep Your Medication, Either: More Obamacare Issues Reveals...

Posted By: Watchman
Date: Tuesday, 10-Dec-2013 14:48:37

If you like your medication…too bad, because you probably won’t be able to keep it – at least, not without paying a fortune for it.

Prescription drug coverage – or the lack thereof – is the latest unpleasant surprise consumers will face courtesy of Obamacare.

Here’s how prescription drug coverage “works” under Obamacare.

Under the ACA, prescription drug coverage is one of 10 “essential benefits.” This means that all plans are required to cover at least one drug in every category and class in the U.S. Pharmacopeia, the official list of approved medicines. Many drugs will not be covered at all, and if a consumer needs a certain medication and pays cash for it, the cost won’t count against out-of-pocket caps. Lists of drugs that plans agree to provide some coverage for under Obamacare are called “formularies.”

Dr. Scott Gottlieb explained how this works in an article for Forbes:

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."

In Dr. Gottlieb’s example, the drug Copaxone was partially covered under the plan’s formulary.

But what if a medication is not covered under a plan’s formulary?

The out-of-pocket caps only apply to medications that are covered on a plan’s formulary. This means that if a patient needs a drug that is not listed in their plan’s formulary, they may have to pay for the full cost of the medication. To add insult to injury, 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).

So, how does one find out if the medications they are currently taking are covered under Obamacare plans?

It isn’t easy – in many cases, the Obamacare exchanges don’t make their formularies accessible by a simple click on the website. In some cases, the information doesn’t seem to be available at all.

more: http://www.thedailysheeple.com/you-cant-keep-your-medication-either-more-obamacare-issues-revealed_122013