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ObamaCare Clusterfuck: Differential access to prescription drugs for those forced into ObamaCare

The Hill:

The research from consulting firm Avalere Health points to a little-known facet of policies on the ObamaCare exchanges known as "utilization management controls."

The controls allow insurance companies to limit access to certain medications to try and control costs and prevent abuse. People who enroll in ObamaCare plans are likely to encounter the hurdles if they're prescribed brand-name cancer or mental health drugs, Avalere found.

At least 51 percent of brand-name mental health meds come with special controls on the exchanges, compared with only 11 percent on the employer-based market, the analysis found.

Researchers noted that the presence of controls for psychiatric drugs was possible but unknown on roughly one-third of exchange plans and 40 percent of employer-based plans.

Fewer hurdles exist, meanwhile, to HIV/AIDS drugs on the exchanges, where only one in five plans subjected the medications to special management. As expected, an even smaller number of plans on the employer market placed barriers in front of those medications.

Utilization management requires patients and doctors to take extra steps to show they're using prescription drugs properly.

The controls may include policies like "step therapy," when patients must try cheaper medications before receiving coverage for an alternative that costs more, or "prior authorization," which means an insurer grants coverage of prescriptions on a case-by-case basis.

Insurers argue the policies prevent abuse, lower risk to patients and decrease drug costs for everyone. Consumer advocates tend to oppose the controls, arguing they create frustrating and sometimes dangerous barriers to care.

If the insurers were arguing in good faith -- BWA-HA-HA-HA-HA-HA!!!! -- they'd want identical controls on all policies. They don't. So this is just another way of jacking up profit by denying care.

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Alexa's picture
Submitted by Alexa on

in 2009, just prior to passage of the ACA in 2010.

Just another example of why the PPACA will be shown to be a "fiasco."

Prior to the ACA, our RX co-pays were $5 and $10, then $7 and $12, then $10 and $15--and the Fourth Tier (that I believe this diary refers to) didn't exist.

Now our RX costs are astronomical, just like the rest of our health care costs.

Heck, in a few more years--most Dems will probably be found hiding out in Nome, Alaska! (if they don't repeal and replace this law).

Just wait until all the individuals and families with Group Health Insurance have their plans turned upside down, like our plan was. [The numbers of Group beneficiaries are were approximately 45% of the population in 2011. Didn't find more current figures, although they may be available.]

Of course, even Governor Dean admits that one of the main purposes of the ACA is to dismantle employer-sponsored group health plans. So convenient, that none of the Dems would own up to this until AFTER it was passed. Then they had no problem cropping up on all the business and finance channels, talking about the "unintended consequences" of the law.