I have health insurance. For one of my medications, I cannot take the generic form, so I must have the name brand. With my job I started 2 years ago, came new insurance. I'd always paid more for my name brand drug (maybe $45 or so). But suddenly that price jumped to $400 per month with my new insurance. This is opposed to the $5 copay if I could take the generic. You see, it's "non-formulary". I was denied coverage, even though I could not take the generic. It's just not an option. I appealed it to the very top of the parent company. I was denied regardless of medical necessity. They officially didn't care. (Irony Alert: I was helping my employer fight medical necessity denials from Medicare)
Fast forward to 2015. I figured the price would go up with a new year. To our shock and dismay, my medication I depend upon every day was now $1,000 per month. Wow. Just because they can. And they still officially don't care.
Fortunately, my husband now qualifies for health insurance benefits with his part time teaching job. With this new insurance, it will now cost us a grand total $40 per month for my name brand medication. Why? Just because they can. They perhaps care a little more for their customers.
MY POINT: Coverage is not care. In both examples, I have health insurance. One insurer has decided to cover my name brand prescription (for a slightly higher price), and the other chooses to not cover the name brand at all, regardless of outrageous expense or needs of the patient.
Addendum: My son's medication, for which there is no generic, is also not covered under the first insurance plan. For my medication they denied me because there is a generic available, but I "choose" not to take it. In my son's case, there is no alternative, but they still choose not to cover his medication. Just because they can......
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