So, not only are millions of Americans finding out that they can’t keep their health plans and losing access to their doctor because of Obamacare, many may not be able to keep their prescription drugs. The reason, Scott Gottlieb wrote at Forbes, is because of a quirk in the law that allows states to exclude certain drugs from coverage:
The out of pocket caps on consumer spending only apply to costs incurred on drugs that are included on a plan’s drug formulary. This is the list of medicines that the health plans have agreed to provide some coverage for.
If the drug isn’t on this formulary list, then the patient could be responsible for its full cost (with little or no co-insurance to help offset that cost). Moreover, the money they spend won’t count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual).
Some of the published lists do not show all of the covered drugs. For instance in California, Blue Shield’s document states that only the most commonly prescribed drugs are shown in its published formulary. Anthem’s published list is also not comprehensive.
Some analysts have tried to look across the plans, but comparisons are as hard for experts to make as they are for consumers.
One study by Avalere Health of 22 carriers in six states looked at the benchmark plans that the Obamacare plans would be tied to. It found that the numbers of drugs listed as available on formularies ranged from about 480 to nearly 1,110.
Even if your drug makes it onto the Obamcare plan’s formulary, getting access to a medicine can still be a costly affair for patients.
In the same study, researchers found that 90% of the lowest-cost bronze plans require patients to pay 40% (on average) for drugs in tiers 3 and 4, compared with 29% co-pays in current commercial plans. Most of the Obamacare silver plans also require patients to pay 40% for the highest-tier drugs.
Gottlieb notes that many formularies for plans on the exchange will be restrictive, which is terrible news for people who need speciality drugs to treat certain diseases or ailments:
Health plans are cheapening their drug formularies – just like they cheapened their networks of doctors. That’s how their paying for the benefits that President Obama promised, everything from free contraception to a leveling of premiums between older (and typically costlier) beneficiaries, and younger consumers.
But the need to fund these promises will put drug formularies in play for the long run. New medicines will remain off formularies, or make it on after long delays. Patients will find that costlier specialty drugs are simply not covered.
This undermines yet another central talking point for Obamacare; that Americans will be better off financially under the law. That’s already not true for many, given the law’s higher premiums and deductibles. But it’s also not true because some Americans will have to pay out-of-pocket for drugs they need that aren’t covered and won’t count toward their deductible.
Hey, so some Americans won’t be able afford costly speciality drugs that will help treat their ailments, but at least they’ll get free contraceptives under Obamacare, right? Because, if you listen to President Obama speeches and his apologists on talk shows, that’s their answer for just about every criticism of the law.