Insurance changes and Cancer meds

President Obama's affordable health care act has adversely effected the health insurance plans of many companies. A number of employers have been overhauling the health benefits they offer employees, citing rising costs. There are two themes to what they are doing. In trying to control their own spending, employers often are shifting health costs to employees. So the average annual deductible for an individual has nearly doubled in the past seven years. But employers aren't just making workers pay more. They're trying to make them think more about health-related expenses and behavior. Some companies have decided to stop covering working spouses if they have access to coverage at their own jobs. The health law does not require employers to cover spouses, but surveys show that only a minority of companies have implemented a "spousal exclusion." However, employers increasingly offer incentives to get spouses off their plans. They may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy. The health law requires employers who offer coverage to employees to also offer coverage to dependent children, or pay a penalty.

The affordable care act mandates that prescription drugs are one of 10 essential health benefits that insurance plans must offer — among maternity and newborn care, preventative care, hospitalization and mental health — the ACA makes drug coverage a core part of health insurance, and it eliminates insurers’ ability to tack on a prescription drug benefit plan to a health care plan at an additional cost. Patient copays vary regarding the type of plan, type of medication, and the prescription drug company's formulary. The ACA requires insurance plans to cover at least one drug in every category and class in the U.S. Pharmacopeia, the official list of approved medicines. Patients and their doctors can request and gain access to clinically appropriate drugs that aren’t covered. Plans maintain their own preferred-drug lists, or formularies, and the cost for the same drug can vary significantly between plans, which is especially important to note for consumers with chronic conditions such as cancer.

Yesterday, I received a call from my prescription drug company. My oncologist had sent in two prescriptions for me. One of the medications was not listed on the company's formulary. The voice on the other end of the phone advised me that the cost of this medication might be higher than others in the same class of aromatase inhibitors. She suggested I contact the insurance company and inquire about the cost of this medication, just hearing her say those words concerned me. We'd already noticed many changes in our health insurance plan since the first of the year and most of those changes were negative changes.

I called the insurance company to ask about the monthly charge for Aromasin and almost fell off of my chair when the clerk told me the fee would be $275 for a 30 day supply. While that might not seem expensive to some people, it was definitely expensive to us especially since we only have one monthly income. After discussing it with my husband, we decided it would be a good idea to call the doctor's office and see if there was an alternative medication. Thankfully, when I called and spoke with my doctor's nurse, she gave me some peace of mind. She assured me they would do everything they could to find a medication that would fit into our budget as well as combat the cancer. 

My heart goes out to those who need expensive medications and are unable to afford them. Some prescription manufacturers offer programs for those on low incomes but many do not. Many doctors offer prescription samples to patients who are unable to purchase their medications but there are also those who do not. It's a sticky situation for those of us who need medications on a daily basis. I am so thankful that my husband's company provides the opportunity for us to participate in their health insurance program and although they require annual documentation to insure me, we have yet to be denied benefits.

There are many different opinions on the Obama Affordable Care Act. Some people are very opposed to it and others are very thankful for it. I have my own personal opinions on it and I won't share them here. Hopefully, most of us realize how blessed we are to live in a country where we can easily obtain necessary medications for illnesses. There are so many countries where this is not the case. Wouldn't it be nice if none of us ever needed any medications? But with the world we live in today, that would never be possible. Good health should never be taken for granted.