"Why on earth does acne medicine and birth control meds require preauthorization? Why every month do i have to drive down to doc office to pick ip prescription for ADD meds. Why every month doc has to call in acne medicine? "
That is possibly your plan, and possibly the specific med’s effects, not ACA. Or how your doc wishes to prescribe. My kids need no monthly re-auths. But some prescriptions don’t run endlessly because they need to be monitored. Talk to your docs.
My aged mother, who was on a host of meds, didn’t need monthly re-auths either. In contrast, when given Cipro or similar high impact Rx, sure, I got one refill- if any.
"Why on earth does acne medicine and birth control meds require preauthorization? Why every month do i have to drive down to doc office to pick ip prescription for ADD meds. Why every month doc has to call in acne medicine? "
Actually the reason that most ADD/ADHD meds have to be called in, is because stimulants are a controlled substance. Even if you had no medical insurance, and were paying cash, your doctor would still have to give you a separate prescription for each month. My doc used to send them every three months by mail to my house. This is a govt issue, not an insurance issue.
As for the acne meds, we are just starting those, but there seems to be pretty big hoops to jump through. There is a concern over suicide, birth defects, and monthly blood tests. Once again, nothing to do with insurance. Some drugs have a very high risk and they require stricter control by the government.
I have had several aca compliant (exchange) plans as well as Medicaid. Not one required pre authorization for any meds or procedures I’ve had done. I just had a new implant placed. Didn’t need to do anything for that either.
For meds, I got refills for a year with one prescription.
I understand that add med are controlled substances and whether i paid without insurance or not id atill have to jump through these hoops but it just adds to the healthcare costs and does not stop the dispensing of such meds. Yes its a government issue and so is obamacare. Regulation adds to costs. The acne medicine im speaking about never required preauthorization until this year. Its topical. And the birth control pills same thing. However yes their are some drugs that require monitoring so someone with no health background is questioning your doctors medical opinion. This stupidity almost killed my d. Bureaucrat knew more than my d’s doctor and you know what it cost insurance company thousands more. They not only paid for test, the surgery but two er visits because of their stupidity. And yes more and more drugs are requiring preauthorizations preventing people from obtaining neccessary medications and requiring doctors to hire additional staff just to deal with this.
Just checked rates today in our new state for D2. Actually about $15 cheaper per month than her comparable plan in our current state. But my COBRA is going up $50/month next year.
And no the drug does not need monitoring. It has nothing to do with that. Its been prescribed before with refills but now it cant be written as a refill and requires preauthorization. New as of 1/1/2015. ADD medicine that never required preauthorization is also new as of 1/1/15 and ditto for birth control pill. Its the insurance company not the doctor. ACA created the formulary lists not the insurance companies.
Moving from one location to another would necessitate a change in plans, for one. That’s what happened with my D. She had one exchange plan when she lived in IN. When she moved to WA in mid-2014, obviously the IN insurance wasn’t going to do her much good, so she got a WA exchange plan.
D didn’t need pre-auth for her birth control, or her acne medication for that matter. So those hoops are not ACA hoops. They’re probably insurance company hoops. Insurers know very well that the more barriers they place between us and our medical care, the less medical care we’ll get and the less they’ll have to pay for.
This is not correct. The insurance companies create the formularies. That’s why people are advised to check the formularies of the various plans they’re considering buying, to be sure that their drug is covered by that particular plan.
“ACA created the formulary lists not the insurance companies.”
We had formulary lists long before ACA came around. The hoops you have had to jump through are insurance company hoops, not ACA hoops. These difficulties existed before the ACA went into effect. I remember changing over insurance companies long before Obamacare and having to deal with ADHD medication preauthorizations that were not approved. I had to change my son’s medication from something that was working well, to something we had never tried. It was difficult then, just as it is now.
Sorry, I missed this post. There’s about $2500 savings right there. So Obamacare works better for some families than others. I do worry about how much this is costing the government, but in the end I guess they’ll just print more funny money.
For next year, I am moving my only dependent, D2, to her school insurance, which is very comprehensive and is only 150/mon. By removing D2, my deductible is much lower (single vs family) and I could afford the platinum plan at work. Overall, my total monthly premium will be lower.
People should do some math to see if it would make sense to put their college students on their school’s insurance rather than on their family’s health plan.
“D didn’t need pre-auth for her birth control, or her acne medication for that matter. So those hoops are not ACA hoops. They’re probably insurance company hoops. Insurers know very well that the more barriers they place between us and our medical care, the less medical care we’ll get and the less they’ll have to pay for.”
If insurers are dumb enough to think they will save money by making it tougher to get birth control pills, they’re awfully shortsighted. They ought to be giving those out for free, to save money. Mine cost $2.50 a month.
I agree, busdriver. But insurance companies, like American corporations in general, aren’t necessarily long-sighted or rational. Many young Americans are insurance itinerants, and the companies may figure that by the time a young woman becomes pregnant, she’ll be somebody else’s problem. It’s stupid for sure. Plus, like I said, it’s a barrier.
Notice some of the misunderstandings here? One says his/her state, insurer, policy, and/or doc/phramacy do things one way- and some decide that’s how it Is for all? Take a look st your own options.
D doesn’t need her BC Rx renewed monthly. I don’t know why someone needs to drive to pick up a paper copy.
Remember that costs are more than just the monthly. That may go down or up, but other than some employer Cadillac plans, your end costs depend on how you use your insurance.
Anyone who thinks I’m lying about several plans can ask LasMa and others for confirmation. I’ve detailed them on the other ACA threads and privately.
It’s because I’m a student and one semester had school coverage. Before and after I had different plans. Then a few months I qualified for Medicaid. Different plans before and after. Etc
Is there any website to go to where I can find the cost in my state without giving them my name, address, etc. I don’t mind filling out all the other stuff, but am just curious as to pricing and don’t want to be called. Currently through Cobra, we are paying 1,700 for a family of 4, which includes dental…$5k deductible.