Did you know that “Out of Pocket” expenses for prescription drugs are not even considered in the tally of your costs to get out of the donut hole if those drugs aren’t in the insurance company’s formulary? Of course if it was in the formulary, the total cost wouldn’t be coming out of your pocket.
Example: I paid 448.00 a month for Fioricet, a non controlled substance but a prescription drug for migraine headaches. I’m allergic to generic drugs which though they have the same active ingredients, have different fillers, dyes and preservatives in them. The generic, by the same company, Watson, costs 39.00 for the same amount. No matter how many doctors I’ve had write and call for exemptions, I have never received one.
So it’s the formulary that’s the problem. Or the lack of fair play by the insurance companies and the lack of enforcement by the government. If the doctor prescribes it, and the FDA approves the drug, and I pay for brand name coverage, why is the insurance company allowed to intervene?
America has an Alice in Wonderland health Care system. “Out of pocket” should mean “out of pocket”, but it doesn’t. There’s a new category. It’s called “Troop” (True out of pocket) and who determines that? The very insurance companies who provide the insurance. Conflict of Interest? Not at all, they make the deals, they make the profits, and I pay all my social security checks for medications.
So I don’t understand why anyone is worried about the government coming between a patient and a doctor. A “for profit” insurance company is already doing that. And I’ve tried for exemptions with three of the major Part D Health Insurance companies to no avail, doctors written notes as well as my own.