ObamaCare and You: Will your current medication list be covered under your new health plan? ~ Part III

Prescription Bottles

I received an e-mail today from the Health Insurance Marketplace urging me to go online to purchase my health plan. The e-mail I received also stated that most of the technical difficulties they were having with the website have been ironed out. So, if your state does not have it’s own website for purchasing insurance, try the healthcare.gov link again. If you would rather call and apply via the telephone, call 1-800-318-2596. The e-mail also gave a link for counselors in your area as well as a link to download an application form so that you can mail it in yourself.

If you do not have time to apply right now or wish to wait a week or two before applying, then you can prepare a list of “have-tos” or things you need to research until you plan on purchasing your health plan. Please remember that in order for you to start using your health plan on January 1, 2014, you have to apply by the 23rd of December. So in the meantime, you may want to write down the list of medications that you are currently on, if any.

I am asking you to generate this list because you have to make sure that the health plan you decide to purchase, covers the medications that you are currently on. You want to make sure that there are no gaps in managing your health because of delays in obtaining authorizations for medications that are not covered by your plan.

Just because you have a health plan that covers prescription drugs, does not mean that all the medications that exist in this world are covered. Wouldn’t it be nice to have a $5 co-pay for any medication we want? Well, that is not how prescription coverage works. Every health insurance plan has a formulary. formulary is a list of drugs that are covered by an insurance plan. Medications on this formulary may have different co-pays.

Here’s an example: Ibuprofen tablets, celecoxib capsules and  diclofenac patches are all used for pain. Ibuprofen tablets may have a $10 co-pay, celecoxib capsules do not exist in a generic form, so a 30-day supply may have a $25 co-pay and the diclofenac patches which are a newer form of this drug and does not have a generic may have a $50 co-pay. Even though all of these medications are for joint pain, there are different prices for each medication. Some health plans may divide different medications into different levels called tiers:

Tier 1 co-pay: $10 (ibuprofen may be listed in this tier)

Tier 2 co-pay: $25 (celecoxib capsules may be listed in this tier)

Tier 3 co-pay: $50 (diclofenac patches may be listed in this tier)

So in the above example, the health plan has 3 different co-pays for three different medications used for joint pain. Some health plans may have restrictions as well. For example, they may not pay for a Tier 2 medication unless you have tried a Tier 1 medication first–and yes, the tiers are related to the cost of the medications. So don’t be surprised if you have to pay a very high co-pay when your doctor writes a prescription for some great new drug on the market. The great new drug may not be covered at all! Health plans place restrictions on some drugs because there may be other drugs on the market that may do the same thing for a lower price, which will be great for your pocket and for the health plan’s pocket as well.

To find out if your medication is covered under the plan you purchase, you either have to view the health plan’s formulary online if it’s available, or you have to contact the health plan that you plan on choosing and ask them if they cover the medications that you are taking. Most insurance companies should have their formularies online.

Some people have not had any problems with the website and were able to purchase a health plan.  The government is now asking people not to wait until the last minute to purchase a plan. I am also asking you not to wait until the last minute to purchase your health plan. You really do not want to be rushed into purchasing just any health plan.

So my suggestion to you is to go online as soon as you can to purchase your health plan. So, gather all of the information you will need such as your projected 2014 income, your medication list and your preferred doctors, if any. It is better to be prepared so that you’re less stressed when you finally get onto healthcare.gov. I am at the edge of my seat for you and will update you accordingly. Happy preparing!

~Dr. Dee

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