How Obama Care has impacted me in regards to “formulary” medications

I am one of the lucky ones. I am on Medicare and pay for extra benefits (an enhanced plan).  Everything is usually covered and medications have never really been a hard thing to get. However, that was until 2017.

Most medications I was able to get with no problems at low costs. A few of my medications needed prior authorization and I never had a problem getting those except for one that I am still fighting and has due to unusual reason.  However,now things have been moved to a category where they have to meet a “Formulary”

I am just learning about it, but I can tell you it is causing heart ache for not only the patient, but the pharmacies, the doctors and I even think the insurance companies.

I usually write about bipolar disorder or mental health advocacy, but this is much more than that.  The medications I am talking about are medications prescribed by doctors other than my psychiatrist.

My understanding, and I might not understand it all, but it is what I have gathered so far.  If I need a certain medication, and so far it has been 3 out of 4 that have been prescribed (not for mental health reasons), I have been told that they do not meet the formulary.  What this used to be called is “need prior authorization” and it was usually pretty easy to get.  However, now, it takes a lot of jumping through hoops and whoever or whatever is at fault has made it virtually impossible to get medications that used to be covered without a problem.

There are things I must try before taking medication.  I understand that especially if there is a generic. However, it is not just a “generic issue.”  It literally takes a lot of work on behalf of doctor’s offices and pharmacies to figure out what hoops to jump through.  I have tried calling the insurance company and so have they.  They will no longer tell you what other things must be tried and the pharmacy nor the insurance company would tell me the generics. ( “we are no longer allowed by law”)

I know this is different because I used to be able to call my insurance company and discuss what medications were in which tier and know exactly why a certain medication was not being covered. Now it is all some kind of secret that the doctors have to figure out.

This is of course my take on all of this and I am not sure what is exactly to blame. All I know is I am now unable to take two desperately needed meds that my doctor has prescribed because he/she feels they are the best for my current medical conditions and I can’t get them until this “formulary” is meant.

I had one person at one doctor’s office tell me that she spent hours trying to get to the bottom of it all and still has not made much leeway.  How stupid is that?  She has wasted valuable time on something that she should not have to focus on.

I don’t know for sure this has to do with Obama Care, but have been told that things have changed in 2017 and the people I have talked to have said it is because of Obama Care.

I don’t usually get very political and tell my side of things directly politially, but in this case I am going to.  However, I will try and refrain from saying who I voted for and what party I am affiliated with.

President Trump and many Republicans want to repeal and replace Obama Care.  I know a lot of the reasons why and agree the current system is not working for nearly as many people they claim to be helped by it.  Americans  are in favor of it are being helped because they have no job or are on medicaid love it and don’t want to see the advantages taken away and I don’t blame them.  Medical care and prescription meds are expensive. Some aspects of Obama Care in my opinion are great like it did away with the stumbling block of pre-existing conditions.

However, when all these changes are causing doctors’ offices to work harder to get medications for their patients when they are already overworked is ridiculous.  Another thing that makes me mad is that my insurance company never warned  me that this was all going to happen or I would have switched to a different enhanced plan.

Like I said, I am not going to say whether I voted for Trump or not as that is not really relevant. I am not even going to say that Obama Care should be replaced and repealed although you can probably tell my feelings about that.

What I am going to tell you as far as what I have been going through with getting vital medications is ridiculous and others should know. The Democrats who think that Obama Care is so wonderful and think that it is such a godsend should have to deal with having to pay $500 a month for a medication they need and used to be able to get, but now it does not meet the formulary so they have to pay much more.  This is ridiculous and more people need to start speaking out. Politicians have great insurance so they are clueless as to what we others are going through.  I am not talking about the elderly who pay thousands of dollars on meds and end up going bankrupt ( a disgrace). I am talking about average citizens having to fight so hard when they are sick to get a medication that they never used to have a problem getting because somewhere in the piles and piles of pages in Obama Care it says that the formularies must be used.

If you are having this problem, I would suggest you would write to your politicians.  However, I have never had any luck with doing that, but maybe if enough of us do it, it will have to be changed.

I just hope that when and if Obama Care is replaced and resolved, this “formulary thing now used in 2017” is one thing they get rid of.









2 thoughts on “How Obama Care has impacted me in regards to “formulary” medications

  1. I am not a fan of the ACA (popularly known as Obamacare), but I have been lucky enough to see both sides of it because my immediate family has been both positively and negatively affected by it. I say “lucky” because having been both positively and negatively affected by it helps me to have a better overall picture than someone who has only been helped by it and may only see the positives or someone who has only been hurt by it and may only see the negatives.

    First of all, if you are just now seeing these changes, I think it’s unlikely that it is a result of Obamacare. Changes from Obamacare started several years ago; if these changes to your formulary were a result of Obamacare, you should have seen them way before now. There are people all over America who are blaming Obamacare for things it is not responsible for, solely because they listen to biased media on one side, and that’s unfortunate. (I am not at all indicating that is the case with you, Michelle, but I have seen it with so many others.) Some of them work in our hospitals, our pharmacies, and our health insurance companies, and some are just mouthing what they think is going on or what they’ve heard from someone else who may not know, either. So I can’t imagine that these particular changes you mentioned are a direct result of that this late in the game, but I honestly don’t know.

    Second of all, people tend to think that Obamacare is for people who don’t want to work. If you’ve tried to find a job in a non-professional field in the last five years, you know that finding full-time work is nearly impossible. Companies would rather hire two part-time employees and offer no benefits than to pay one full-time employee with benefits. So, MANY of the people more positively impacted by Obamacare actually work at least one job, and many of them are working more than one. Before Obamacare, my husband had no health insurance at all. He couldn’t get it because he couldn’t find a full-time job, and none of the part-time jobs he worked offered benefits. One of the ways it positively affected us was that he was able to be covered, for the first time in years. You wrote about the pre-existing condition issue, which is also a positive, and I have friends that have been so grateful for the part of Obamacare that allows their adult children in college to be on their health insurance until age 26. So those are several really good ways that Obamacare has helped decent people who aren’t just trying to abuse the system.

    Thirdly, there are definite negatives. While I am perfectly okay with paying more in taxes so that someone who has less than I am is able to survive, I don’t think that I should have to go broke to do that. And that’s where some people are right now. Their own health insurance has gone up so high as a result of the implementation of the ACA, that they are suffering greatly. That’s not right. Another negative is that The Healthcare Marketplace has way too many kinks in it that should have been worked out long before now. The left hand doesn’t know what the right hand is doing over there. You have families that were receiving health insurance through the ACA, were updating their information just as instructed, but were fined hundreds of dollars because ACA lost the paperwork and won’t reassess it. That’s how my family has been negatively affected by it. WE didn’t make a mistake, but WE are required to pay for it. That’s not right, either. And neither is fining people who can’t afford it even after the tax credits. In two years, my husband’s medical insurance has tripled, and it’s THROUGH the ACA.

    Most every law or policy that’s ever been written affects some decent human beings positively and some decent human beings negatively. That’s just reality. Ideally, when a law or policy is enacted, we should look at how EVERYONE is impacted by it, and weigh the good versus the bad. I don’t think people should have to die just because they are poor, ever. And now that we live in a society where hard work often doesn’t result in monetary success, we have more people who fall in the category of “poor.” I don’t know what the answer is. I don’t think the ACA, as it is now, is the right answer. But I don’t think doing nothing is, either. I am hoping that whatever replacement the Republicans come up with works better, but I am not holding my breath.

    • I should clarify that I am “not holding my breath” because getting affordable healthcare for all is just an extremely difficult undertaking to begin with, not because I was insulting Republicans.

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