General Discussion
In reply to the discussion: If you unfairly, wrongly and very publicly attack someone, shouldn't you apologize? [View all]Yo_Mama
(8,303 posts)Because he's mandated to buy an ACA plan, he doesn't have choices in his area, so he can't get an ACA plan that covers the drug, and ACA coverage is leaving his wife uninsured for this purpose. There's a lot of counties in the US in which your ACA choices are pretty much one company, or sometimes two. More than half, to be precise. Here's an NYT article over the issue:
http://www.nytimes.com/2013/10/24/business/health-law-fails-to-keep-prices-low-in-rural-areas.html?_r=0
That's a hell of a situation to be in, and instead of us all trying to pretend his wife isn't in this situation, we should be working to change it.
He's not the only one, and this problem has been pretty widely discussed.
The cutest part is that the insurers are trying to block programs such as the one William Pitt's wife is now using:
http://www.fiercepharma.com/story/express-scripts-stops-covering-key-big-pharma-drugs-cost-effectiveness-grou/2013-10-10
Here's the proof that you are wrong:
Where I live, this is the BC/BS formulary, and there is no other company selling ACA plans (in much of rural GA). So this is what we get if we are forced to buy ACA insurance.
http://www.bcbsga.com/GAExchangedruglist4.pdf
MS drugs with no coverage at all include Aubagio, Avonex, Betaseron, Copaxone, Gilenya, Novantrone, Tecfidera.
Here's a WebMD list of MS drugs:
http://www.webmd.com/multiple-sclerosis/guide/ms-drug-treatments
The only drug available for ACA MS sufferers in GA is Rebif (Tier 4, prior authorization required, meaning they'll try to avoid paying for it, and you might not get it, hahahahah this means they demand multiple MRIs, which you have to pay for, and if you can't pay for them no luck, sucker) and Tysabri, which you can get on Tier 4. There are no orals. Tysabri is administered IV only. Rebif would be the "common" usage drug, and it's laughable that they'd put that on PA. It's really just a way of denying coverage.
A lot of MS patients are shit out of luck with ACA, and it is much worse than it is now on most policies, because under ACA, if the drug is not on the formulary it doesn't count toward your deductible or OOP. So you are just flat uninsured.
That people are chopping up this poor guy because he's desperate to help his wife is sick. Just sick.