Remember that Martin Shkreli guy that raised the price of a single medication to over 5000%? Americans were outraged at how a person could be so insensitive and cruel taking advantage of the public that needed this medication. However, during that hoopla, I didn’t see those same pitchforks and torches trying to battle the health insurance industry? Why is that? Perhaps we know very little about how to tackle and fight for our needs when it comes to medicine.
I was reading an article where Biogen’s new treatment for spinal muscular atrophy (SMA) was going to cost $750,000 for the first year and $375,000 annually after that. If you were in need of that mediation would you complain that you can’t afford it or would you fight to get it and let your insurance company suffer the cost? I’m willing to bet that most of you would just throw in the towel and seek another remedy instead. Folks, it’s time to start engaging doctors to work beyond just diagnosing and writing prescriptions for us. We must do more to advocate and secure a solid treatment plan and hold insurance companies feet to the fire. My reasoning for this is that insurance companies made a choice to manage healthcare. Instead, that very industry that wines and dines pharmaceutical reps and hospital administrators are very aware of the game they are engaged in. However, the insurance industry would rather pin the problem back on the patient or consumers rather than the physician that wrote the order or the pharmaceutical company that set the price of the medication. This is when you get that dreaded call that you need to begin a generic regiment because of your insurance won’t pay. This is utter nonsense! Push back folks! The Affordable Healthcare Act clearly says, “A doctor can request that the plan cover the medicine “by exception,” even though it is not on the plan’s formulary if he or she feels that another medicine will not work as effectively for you, or if, for example, you are allergic to the other medicines on the formulary.” Additionally, that same law says, “If your doctor requests an exception and it is denied, you can further appeal that decision by submitting a letter of appeal to your insurance company.” Get that medication you need instead of rolling over at the mercy of big industry.
Of course, we all have our pharmacy that we use. It may be convenient or has someone we know and trust. But is that pharmacy in-network with your policy? Just because your insurance is accepted at the pharmacy, you may be paying more for medication because it is not entirely in-network. You can find out if you are in-network by visiting your insurance company website or calling to locate an in-network pharmacy.
What if you don’t have insurance? This is where those without insurance may go “huh?” and those with insurance may slowly get angry. Research has shown In some cases; it is less expensive to pay for the medicine without plan coverage than with plan coverage. I’ve actually tried this. I take Adderall XR for ADHD. With insurance, a 30 days supply costs me $20. But if I didn’t have insurance the standard price would be over $190. After talking to the pharmacy, I was able to download prescription coupons where my cost would be $15 each month. Yes, I pay less in my prescription by not disclosing my insurance to go around to get my medication. Sure, I save $5 but folks, I’m not using insurance when I have insurance. How crazy sounding is that? This is why we dislike our health care system and hate insurance companies in general. It’s a game where the rules change at a whim, and we have no idea what the next moves are? But this example demonstrates a serious flaw in our affordable health care efforts.
If I needed a million dollar a year medication for whatever reason, I would be the first to do everything in my power to get it. Naturally, my doctor would be working overtime to ensure that I get it if he determines that it is in my best interest of health. I assure you that I would not be paying full price or a reduced price. I would be paying my first tier co-payment of $20 instead of a million. I didn’t invent the rules, but I am certainly going to ensure that the insurance industry abides by the law.
It’s time to let the insurance companies and pharmaceutical industry to declare war on each other. Lately insurance companies have been at war with consumers, and that method doesn’t work. The law is written clearly to support our needs and requirements. Let’s do our part by pushing back and investigating our policy and use it to our advantage. Don’t be tricked into carefully crafted marketing words. Use your plan and show the pharmacy and insurance company the law. It’s really simple. The battle should have always been between pharmaceuticals and the insurance industry all along. They figured they would throw a wrench into the effort to slow us down in the process. Let them know delay and deception of their policies won’t work anymore!