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.