Obamacare and Drug Costs

Despite a ban on discriminatory health insurance practices against the sick, insurers continue to charge higher rates for treatments required for the management of chronic diseases. The goal here is for insurance companies to offset the cost of such clients, so that they can offer lower monthly premiums to healthy people who will yield a profit and help share the burden of those expensive treatments.

The loophole here is that, while Obamacare does force all healthcare plans to cover prescription in all categories, it only requires each plan to cover one medication in each category. There is also wiggle room regarding the dosage. This makes it very difficult to get the coverage you need, especially if you need multiple medications.

Insurance companies can no longer reject sick people for being sick, but they still have investors, and they still need to turn a profit, so this is their solution. What this means is that the work is not finished in regards to the American healthcare system, and in the meantime, Americans need to be creative in looking for other solutions to meet their needs at the level that every other industrialized country does.

ACA and Drug Costs

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One major step would be for American insurers and medical institutions to challenge Big Pharma and negotiate more reasonable prices. In Canada, the same drug manufacturers sell Actos, for example, a treatment for type 2 diabetes, for a fifth of the price of the same product in the USA. The American product costs $280 at Walmart. It’s not like pharmaceutical companies aren’t making money in Canada. Clearly we are getting punked over here.

So if your insurance provider refuses to cover your treatment giving you what you need costs them money, then you might find that it’s cheaper just to take your business elsewhere. You’re still giving your money to the same drug company, but at least this way it’s less.

The way it works now is that there is a list of drugs that is covered by each health plan, and anything that isn’t on that list isn’t covered at all. The medicine you need might not be covered by any health plan, and, if it is, you will have a hard time choosing the correct health plan before you get sick and find out what you need.

If you have a serious medical condition that requires an expensive treatment, being on the list won’t save you, as you will be paying about 40% of the cost of the treatment, which is easily enough to bankrupt most Americans in less than a year. For multiple sclerosis, for example, you would still be spending nearly two thousand dollars a month on copaxone. That’s nearly double the national average for a mortgage payment.

This is why other countries put price controls in place to keep pharmaceutical profits within a reasonable range. There is a level of human suffering that can’t ethically be allowed in the name of increased profit.

Americans are still paying much more for the same drugs and treatments than everyone else in the world is, and we can’t afford it. We are sicker than the rest of the world, we have less effective care than other developed countries, and we have the most expensive care in the world. That needs to change. Insurance providers alone can’t solve this problem. Only a big picture approach that involves proper education of the public, cost and profit disclosures, and some solution oriented, rather than election oriented legislation, can fix this problem.


Lucas ProfileAuthor: Lucas Tolbert, interested observer.