Pre-Existing Medical Conditions May Be Covered But The Drugs to Treat Them May Not Be


One of the few attractions of Obama’s socialized medicine program was the requirement that all pre-existing conditions had to be covered. In all of the lying and hype to stupid Americans, they wanted us to believe that not only were our pre-existing conditions going to be covered but so were all of the medicines necessary to treat them. Furthermore they told us that it would be at an affordable price.

Prior to Obamacare being forced upon us, I was uninsurable due to be obesity, type 2 diabetes coupled with my age of over 60. After Obamacare went into effect, I could finally purchase individual insurance, but for my wife and I, the cheapest plan we could find that would cover my pre-existing conditions would cost us $816 per month. Oh yeah, it had a $4,000 deductible and then it only paid for 60% of covered items.

I am fortunate however in that I do not have a medical condition that requires a lot of expensive medication. A number of people with those types of conditions discovered that in 2014, some of their medications were no longer being covered by their insurance plans because of the costs. That left people with the alternative of not paying their bills or mortgage and not eating in order to afford their life saving medications or they just go without and die early. That’s one reason I often refer to Obamacare as the medical program for early death.

One of the companies involved with providing covered prescriptions is Express Scripts Holding Co. or ESRX). They oversee the prescription plans used by many insurance companies that in turn provide service to individuals and employers. They cover nearly 85 million patients.

In 2014, ESRX had placed 48 brand-name drugs on their exclusion list due to the cost of the drugs. For 2015, they have increased the number of excluded drugs to 66. Among the drugs no longer covered is Simponi, a popular drug used to treat rheumatoid arthritis, which can be an extremely painful and debilitating disease. The reason they no longer cover Simponi is that it costs around $3,000 per month.

Epogen and Aranesp are two more drugs that will no longer be covered by ESRX’s formulary. Both drugs are manufactured by Amgen Inc. and are used to boost red blood cell formation.

Steve Miller, Chief Medical Officer for ESRX said that some of the drugs being excluded can cost as much as $50,000 per month and insurance companies cannot afford that kind of coverage. He went on to say that if something isn’t done to bring down the costs of new and expensive drugs that the costs of healthcare could double to half a trillion dollars by 2020.

CVS Health Corp is another company that provides a formulary to insurance companies. In 2014, they had around 70 drugs that had been excluded from coverage. They are also increasing their list of non-covered drugs in 2015 to 95. One of their excluded drugs is Rebif, which is used to treat people with multiple sclerosis. The injections cost over $5,000 per month.

Hepatitis C patients covered under the Illinois Medicaid program now have to meet 25 criteria in order for the government program to pay for their Sovaldi medication. Produced by Gilead Sciences Inc., 12 weeks of Sovaldi treatment costs around $84,000.

Other formularies being used by health insurance providers are also excluding more drugs due to the costs. So while Obamacare guarantees that your pre-existing condition will be covered, they are not guaranteeing that your treatment for those conditions will be. With more drugs being excluded, more people are going to be faced with the difficult decision of what to financially sacrifice or to accept a painful lifestyle or an earlier death. Welcome to socialized medicine that truly cares nothing for the patient.

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