General Discussion
In reply to the discussion: Should we add a Dem-bashing clarification to the GD SoP? [View all]sheshe2
(84,060 posts)Bog'ers are able to read and actually understand the facts!
Oh wow Pitt dared, he dared to criticize Obama and a part of ACA that had nothing to do with this President, Do go on Vashta!
No, Obamacare Wont Cover Every Drug Just Like Every Other Insurance Policy
BY IGOR VOLSKY ON DECEMBER 10, 2013 AT 12:40 PM
Under the law, insurers must offer drug benefits as part of 10 essential health care benefits, meaning that millions of uninsured Americans will now have drug coverage for the very first time. But the coverage wont be limitless. Insurers will continue to rely on drug formularies as they currently do in the private market and Medicare Part D to decide which prescriptions are covered and which are not.
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States not the federal government select the benchmark and insurers then offer coverage for the drugs listed in those formularies. What the vast majority of states have chosen is a common small business plan, so you know its saying what will be available in the exchanges and in the individual market generally is whats popular among small businesses now and that seems like a reasonable place to start, the Kaiser Family Foundations Larry Levitt explained.
But yes, there are certain limits: a formulary, for instance, may cover three drugs for treating a certain condition but not two others. Obamacare like all insurers currently operating in the market has a fix for that. ACA regulations demand that a health plan must have an exceptions process in place that allows patients to request and gain access to clinically appropriate drugs that arent covered by the health plan (in addition to internal and external appeal processes). So, if a health plan does not cover a particular drug that a patient absolutely needs, their doctor can certify medical necessity to extend coverage. Insurers have relied on drug formularies before the law went into effect and already have exceptions processes in place, meaning that most will not have to implement significant changes.
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And therein lies the irony of the attack: Republicans have traditionally seen high deductibles and limited coverage as a way to control individual health care spending. Now that Obamacare gives patients that choice, theyre suddenly complaining that the insurance is not generous enough.
http://thinkprogress.org/health/2013/12/10/3042741/drugs-obamacare-coverage/