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US1.me
Lupus
and MS - bumps in the Obamacare road
ObamaCare
patients with serious pre-existing diseases could face expensive drug
costs
by Jim Angle, Fox News
People
with serious pre-existing diseases, precisely those the president
aimed to help with ObamaCare, could find themselves paying for
expensive drug treatments with no help from the health care
exchanges.
Those
with expensive diseases such as lupus or multiple sclerosis face
something called a "closed drug formulary."
Dr.
Scott Gottlieb of the American Enterprise Institute explains,"if
the medicine that you need isn't on that list, it's not covered at
all. You have to pay completely out of pocket to get that medicine,
and the money you spend doesn't count against your deductible, and it
doesn't count against your out of pocket limits, so you're basically
on your own."
The
plan had claimed it would rescue those with serious pre-existing
conditions.
"So
it could be that a MS patient could be expected to pay $62,000 just
for one medication," says Dr. Daniel Kantor, who treats MS
patients and others with neurological conditions near Jacksonville,
Florida. "That’s a possiblity under the new ObamaCare going on
right now."
In
fact, one conservative group, Americans for Prosperity, is running an
ad on exactly this subject, featuring a woman with lupus, an
auto-immune disease.
She
starts by saying, "I voted for Barack Obama for president. I
thought ObamaCare was going to be a good thing."
But
Emilie Lamb says she later got a letter saying her insurance was
canceled because of ObamaCare, pushing her premiums from $52 to $373
a month.
"I'm
having to work a second job, to pay for ObamaCare,” she adds. “For
somebody with lupus, that's not an easy thing. If I can't afford to
continue to pay for ObamaCare, I don't get my medicine. I don't get
to see my doctors."
One
of the problems is that drugs for some diseases such as MS do not
have generic versions. So without cheaper alternatives and no help
from ObamaCare, patients could face huge personal out-of-pocket
bills, forcing some to skimp on their medications.
Kantor
worries that "this may drive more patients" to not buy
their medicines, "which we know is dangerous," he says. "We
know MS can be a bad disease when you’re not treating it. When
you’re treating it, for most people they handle it pretty well, but
we know when you don’t treat (it), it’s the kind of disease where
people end up in wheel chairs potentially."
In
the commercial market, of course, drugs not on a preferred list would
also be more expensive, but with a major difference, according to
Gottlieb.
"You
go outside that list, you have to pay out of pocket for it, but you
do get some co-insurance, meaning the plans will pay some of the cost
of that."
Some
say ObamaCare hoped to do better on that problem but ran out of time.
Matthew Eyles of Avalare Health, a consulting firm, says although
officials wanted "to be able to make sure that all the systems
were operational in 2014, they realized that they needed to give an
extra year to get those systems changes in place."
Officials
intend to try again next year.
Additional
benefits cost more, though, meaning premiums would have to rise, or
the networks of providers would shrink even further.
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