<p>One thing that I think stands out is with all the contract negotiations with providers, and smaller networks and lower reimbursements resulting, the insurance companies must think it is very expensive to insure the uninsured. Otherwise, why would this be occuring? </p>
<p>Insurance companies did go out and try to get a feel for what the uninsured wanted. People were asked what they prefer, lower prices or larger networks? That has some tiny resemblance to a market. You give the customers what they want. The insurance companies were told by their prospective customers that they preferred lower prices. </p>
<p>The insurance companies say this over and over. When the uninsured were polled, I think last year, 50 percent said they did not buy insurance because of the cost. </p>
<p>This may change in 8 months as people get into the market. Maybe they decide they want a better network and will pay up.</p>
<p>The insurance people that figure out what to charge people are pretty smart. :)</p>
<p>If insurance companies thought they could pay more for services, they would.
The insurance companies may have musjudged what doctors would accept.</p>
<p>Since markets were mentioned, if more healthy people sign up, the networks can be larger and providers can be paid more.</p>
<p>Humana has Sandostatin on the ‘requires pre-auth’ list. I, for one, am thinking he didn’t write a “whole” story. This question isn’t callous, it’s curious. Maybe he gave what’s salient, to him. But to the reader, questions remain. To some readers.</p>
<p>Rereading that article, I think the story is more about cancelling her plan where she had to talk to so many different insurers to confirm coverage than whether she got coverage of the drug. </p>
<p>I am not at all surprised they said it is not covered just before her surgery since that is what insurance companies do with or without ACA. If she had her plan, she knew she was already covered.</p>
<p>Continuing my unPC streak for today, I think it is one ACA supporter’s way of saying. “I believed your promises, but you came back to mess up my mother’s insurance, whats wrong with you!” I got no sympathy for him although I feel for his mother.</p>
<p>My mom’s botox injections for leg spasms were covered by Medicare in North Carolina, but weren’t covered by Medicare when we moved her out here. I blame the ACA. Can I be on an ad?</p>
<p>Wellpoint says they did more than that: they made a mockup exchange (bet it worked better than the initial real exchange) and had their test subjects pick insurance policies. And they say that people preferred cheaper policies.</p>
<p>This makes sense. People complain over and over about airline flights, small seats, charging for baggage, blah blah blah, but when someone goes online to buy a flight, they pick the cheapest one. Not everyone, but the majority of people paying for airline flights for themselves go for cheap. It may be the same for insurance: people might say they want the most expensive hospitals and doctors, but when it comes time to pick an insurance plan, they go for cheap.</p>
<p>"
BioMarin Pharmaceutical Inc. priced its latest rare disease drug Tuesday at $380,000 a year.
But the most interesting thing about the price of Vimizim, the San Rafael-based drug developer’s recently approved enzyme replacement therapy for people with Morquio A syndrome, is that BioMarin isn’t even close to being No. 1. In fact, Vimizim would have to raise its price by more than $35,000 even to reach second place.
The price, BioMarin chief commercial officer Jeff Ajer said Tuesday, is “consistent with other enzyme replacement therapies.”
"</p>
<p>dstark, which network did you check out. In California the formularies are different for the 2014 Obamacare plans on the individual market than group plans or grandfathered plans. Did you look up the formulary for Obamacare exchange plans in Virginia? Maybe in Virginia they are one and the same. Not sure.</p>
<p>Okay, I re-read the Wall Street Journal article and dstark is making unwarranted assumptions. He is asking why she switched from Blue Cross/Blue Shield to Humana. We don’t know because the author didn’t tell us, other than the Anthem Blue Cross plan was cancelled. It could be many reasons. Maybe her doctor or hospital wasn’t in the network for the Anthem plans. Who knows. I think it is ridiculous for dstark to assume the article is incorrect because it left out some details. </p>
<p>btw: I think that “blaming” the State of Virginia for NOT doing something is disingenuous. The ACA gave states the option to run their own plan or be part of the federally-run program. They chose the latter. </p>
<p>I think the LA Times article is a good article.</p>
<p>Bluebayou… Thanks.</p>
<p>I think Humana should be stuck with the cost of the drug. </p>
<p>The patient should be able to switch plans and buy an exchange plan from Anthem. This person can save a tremendous amount of money now. I am assuming her doctors are in her plan.</p>
<p>This drug costs a lot of money. If anybody gets in this situation, and I hope they don’t, call the company that makes the drug. The drug company many times will work on a deal on the cost. They can tell you which plans cover the drug.</p>
<p>“Novartis Oncology is committed to helping patients living with cancer receive the medicines they need.Patient Assistance NOW Oncology offers quick and easy access to information about the broad array of support and reimbursement programs available.
You can get information about our Patient Assistance NOW Oncology support programs in two ways.
Call 1-800-282-7630 to speak to one of our knowledgeable staff dedicated to making access to our programs as simple and convenient as possible; or
Visit our website at: <a href=“http://www.OncologyAccessNow.com”>www.OncologyAccessNow.com</a>
Support for Patients Includes:
Insurance verification
Medicare education
Assistance with denials/appeals
Therapy-specific support programs for out-of-pocket costs
Assistance searching for other sources of coverage/funding that could alleviate or reduce costs for patients
Referrals to Independent Charitable Foundations for assistance with co-pay costs
Patient assistance for low-income and uninsured patients
Patients pre-qualified via phone screening for the Patient Assistance Program (PAP) will be sent a 30-day supply of their needed medication while completing the application.”</p>