<p>Another horror story regarding drug coverage.</p>
<p><a href=“Stephen Blackwood: ObamaCare and My Mother's Cancer Medicine - WSJ”>http://online.wsj.com/news/articles/SB10001424052702303945704579390772732855560</a></p>
<p><a href=“http://www.us.sandostatin.com/patient/carcinoid/reimbursement.jsp”>http://www.us.sandostatin.com/patient/carcinoid/reimbursement.jsp</a></p>
<p><a href=“http://www.oncologyaccessnow.com/patient-access-to-treatment/novartis-oncology-reimbursement-hotline.jsp”>http://www.oncologyaccessnow.com/patient-access-to-treatment/novartis-oncology-reimbursement-hotline.jsp</a></p>
<p><a href=“http://www.us.sandostatin.com/patient/acromegaly/questions.jsp#q20”>http://www.us.sandostatin.com/patient/acromegaly/questions.jsp#q20</a></p>
<p>A friend of mine had 2 carcinoid tumors removed. </p>
<p><a href=“Obamacare stats hard to nail down - POLITICO”>http://www.politico.com/story/2014/02/obamacare-enrollment-numbers-103828.html</a></p>
<p>"Then there’s the McKinsey & Co. survey that made headlines last month: Of all of the people who had bought new health insurance plans through the Obamacare exchanges through December, just 11 percent were uninsured. Score a talking point for the Republicans. But the McKinsey survey, based on a sample of 4,563 people, was conducted so early that health care analysts note that it could have been mostly people replacing canceled plans — with the uninsured people to come in later months.</p>
<p>The survey did find that, of all the people who said they plan to enroll later, 70 percent were uninsured. And it didn’t cover the states that have expanded Medicaid, the other route for covering uninsured people.</p>
<p>On the other end of the scale, New York has been asking its Obamacare customers the question every other health exchange could have asked: “Is (Name) enrolled in health care coverage now?” Based on those answers, the state announced on Monday that 69 percent of the more than 456,000 New Yorkers who have enrolled through mid-February were uninsured. That includes the people who signed up for private health insurance and the ones who will be covered by expanded Medicaid."</p>
<p>And I had coverage – pre-Obamacare – that paid for a drug that the formulary dropped – pre-Obamacare that I had to get coverage approval for via an appeal – preObamacare.</p>
<p>This is not new. </p>
<p>It is distressing, it takes time and energy (which can be in awfully short supply when you’re ill) but it is the way insurance has worked for many, many years.</p>
<p>Everything happened before. And, It’s happening more now. How does that it happened before make it okay? </p>
<p>This is also the commercial cancer ladies problem. It’s very easy to say she is no worse off now but she thinks she is and it’s pretty clear she could be right. Previously, she did not have this problem.</p>
<p>If only the ‘If you like your plan, you can keep your plan’ promise had been kept. Particularly for people who were undergoing care for serious illnesses. Why disrupt their health care plans? So everyone could get ‘free’ mammograms that are now found to be unnecessary? </p>
<p>One thing that wasnt mentioned in the article was what happened with Anthem Blue Cross Blue Shield? Why was there a switch to Humana?</p>
<p>Sandostatin is a tier 3 drug at Anthem if Anthem’s list is correct. Tier 3 drugs are expensive but the drug is covered. The drug was covered before. Was there a change? The drug is no longer covered and the drug list is incorrect. So? Why the switch to Humana?</p>
<p>Whst were the other drugs the woman needs?</p>
<p>Why isnt this mentioned in the article?</p>
<p>If Humana misrepresented what is covered, why isnt this a Humana issue? </p>
<p>Journalism makes almost every other profession look good.</p>
<p>Are people worse off? Or do they think they are worse off? There is a slight difference between the two. If the story was vetted, we would know. </p>
<p>There are so many questions left unanswered. Are these questions ever asked?</p>
<p>This woman worked in her husband’s medical office. If anyone knew how to navigate insurance, she should. </p>
<p>But keep on cheering…and ignore people’s pain. Some have to suffer for the good of the many, right?</p>
<p>I took a journalism course back in my high school days. This doesnt make me an expert in journalism by any means. Especially, with what passes for journalism now. </p>
<p>If my class handed in work that is published today by newspapers like the WSJ, we would have received letter grades of D or F. Or maybe we would have received an incomplete.</p>
<p>I dont remember the WSJ being like this when I was younger. I was interested in stocks when I was a teenager so I started reading the WSJ. This is 1970. Maybe the WSJ was this poor. I was young. I liked reading the WSJ and Barrons. </p>
<p>I used to read from the Dow Jones News Service while I worked. There used to be a huge screen on the trading floor that scrolled the news. I liked it. We would read the news and then the next day it would be published in the WSJ. </p>
<p>Dow Jones used to sell a professional news service. Professionals would pay more to receive the news… maybe 15 minutes earlier than the news from the Dow Jones Regular News Service would be released. The time varied. </p>
<p>So what would happen is there would be a positive news story about a stock that hit the Professional news wire. Professionals would buy the stock or the options. The stock would rise. 15 minutes later the news would hit the regular Dow Jones News Service. The public would buy at higher prices than the professionals. The pros would either sell to the public or just keep the stock if the news had good longer term ramifications. The public ended up paying more. Sometimes, the stock would go down after the public finished buying. </p>
<p>The public didnt know this was happening. The news they were seeing was old. This always bugged me. That is why I wrote the above. :).</p>
<p>Tatin, thank you for the Wall Street Journal article. I have been posting about the narrow formularies for months now. Unlike pre-Obamacare plans, drugs not in the limited formularies are no longer covered. Regardless of what some here are going to say, this was not the norm before Obamacare. </p>
<p>We are going to hear many more stories like what this poor lady must be going through. The law is going to be a disaster for very sick people. It makes me so angry.</p>
<p>
</p>
<p>TBF, this is an OpEd in the Journal, so it will be biased by definition. (No different than the liberal-leaning OpEds in the Times or Post.) All are generally devoid of any pesky facts that dispute the author’s pov.</p>
<p>Of course, I do agree with you on the state of the so-called journalism profession. IMO, J-Schools should be put out of of business given the quality of what they produce.</p>
<p>Bluebayou, you are right. </p>
<p>I dont think this op ed would have flown in my high school paper without a little more vetting.</p>
<p>Moderator’s note: Once again, I want to point out cheering or trashing is not part of this thread.</p>
<p>I also want to point out one person’s gain or loss is just that. They don’t merit detailed coverage on this thread as success or failure of ACA since this thread does NOT CARE about either. It is mainly to see where the issues are without picking a side but people seem to want to take sides and write essays and poems about it.</p>
<p>As bluebayou says, this was an op-ed, just a personal story from a guy who is understandably upset and angry. But newspapers are supposed to inform, so why didn’t the WSJ at least tell us what the insurer’s story is? </p>
<p>Humana is an insurance company, which is in theory supposed to cover cancer treatments. What is their story about how the kind of cancer that the columnist’s mother has will be treated? Do they not cover Sandostatin because they deem it experimental and unproven, or because they cover a different drug, or what is their story? What is the evidence that Sandostatin is an effective drug for her condition? What is the evidence that it is better than cheaper drugs that do the same thing, if there are any?</p>
<p>Drug reps are astoundingly good at persuading doctors to adopt new, expensive drugs. That doesn’t mean new, expensive drugs are better than old generic drugs-- frequently they are not. What’s the truth in this case?</p>
<p>TatinG, Why didnt she call novartis?</p>
<p>If I have to take a drug like this, I am making sure the drug is covered. </p>
<p>Why isnt this mentioned in the article? Why isn’t there enough mentioned to understand? It reduces it to hearsay. </p>
<p>The troubles are always due to the sick individual, the insurance company, the drug company, journalism overall /
Couldn’t possibly be anything else. .</p>
<p>The article points out a major flaw with the new law that many people are not aware of. The formularies have changed for 2014 plans in the individual market. The biggest change is that drugs no longer on the formulary are not credited against the co-pays and out-of-pocket maximums. This was not the case pre-Obamacare. This is a huge change that is not well understood by most people.</p>
<p><a href=“California doctors, insurers face off over reimbursement rates – The Mercury News”>California doctors, insurers face off over reimbursement rates – The Mercury News;
<p>The docs are peeved and they aren’t taking it anymore. Demand for higher reimbursement rates has started…the exchange insurance reimbursement rates are just to low and Dr. are refusing to play the game. </p>
<p>
…see Algebra has it’s practical uses!</p>
<p>So, the agreement is to raise the reimbursement rates…which…will result in higher premium rates…and higher subsidy requirements…and…wait…this was going to cost LESS. </p>
<p>I assume by “the increased cost for the young” TatinG meant that the young are paying more (not a lot more, however) so that the old can pay less. And young men are paying more so young women can pay less.</p>
<p>
</p>
<p>Since when do newspapers fact-check OpEds? </p>
<p>
</p>
<p>Because it is not an “article”. It is an opinion piece. </p>
<p>fwiw: the author of the OpEd is the Prez of a new liberal arts college.</p>