Comments on: Mandated Prescription Drug Coverage

By: Charlie Baker

Charlie Baker — Mon, 10 Nov 2008 03:31:50 +0000

Rob — Very well said. I’m going to lift your comments here and use them to discuss this topic in a new post. Thanks for writing. Let us know if we can help you make the best decision for you and your family.

By: Rob

Rob — Mon, 10 Nov 2008 02:05:13 +0000

I just received notification that our family coverage does not comply with the upcoming Jan. 2009 mandate that must include prescription drug coverage. The entire basis for the Mass Health Plan was to create a health care system in MA that guaranteed coverage for all individuals (not sure if this goal is even within reach) and by increasing the coverage pool, insurance rates would drop significantly. In fact rates have increased and continue to do so. Adding prescription coverage to the mandate forces those who do not use prescription drugs to have to downgrade their insurance coverage to be able to afford a portion of their policy that they will not use. In the end the pharmaceutical companies along with the insurance companies will benefit, while the public will be forced to pay higher premiums. Unfortunately, pharmaceutical drugs are an integral part of our health care system with all their often dangerous side effects, high costs and the “you need to take this for the rest of your life” mentality. While many do need drugs to maintain their illness, I think the general public would be better served by incorporating disease prevention education and alternative health care options (acupuncture, homeopathy, yoga, nutrition, etc…) within this health care system. Perhaps we can have a choice of Prescription drug coverage or spending the extra premiums on alternative (..or more like main stream in my family) healthcare that will inevitably lower health care costs for all. My family uses alternative health care and our doctor visits have decreased sharply during the past 12 years! Our use of prescription drugs are rare if ever! Who’s idea was it to create a health care system that fines families and businesses for not insuring when the costs are so high?

By: Ashley

Ashley — Tue, 21 Oct 2008 23:20:40 +0000

I have enjoyed reading everyone’s posts and I encourage you all to write your state representative, I just did, regarding your feeling about the upcoming mandiated prescription drug coverage. I would like the state to revisit this new law, especially now that we are in a severe economic downturn. The added expense will mean that in our family we will have to downgrade our current coverage to pay for the prescription drug portion. I have checked to see if we can continue with our current plan as is but unfortunately our current provider will force us to purchase prescription drug coverage.

Please write your state representative.

By: Barbara Miller

Barbara Miller — Thu, 09 Oct 2008 06:00:44 +0000

Recently, I have been paying just over $619 a month for my health coverage on an individual plan without a drug benefit–which has seemed incredibly high. With this drug benefit requirement, I will pay just over $726 a month. I have been health- and nutrition-conscious from a young age and almost never get sick or take drugs. I believe that healthy foods, exercise, targeted supplements, and various mindfulness practices and disciplines have worked together and helped me maintain or, at times, regain my health.

I feel that a large part of the health problems in America can be seen when you walk around in average grocery stores and see how much of the food is processed, lacks good nutrition, contains pesticides, preservatives, and other chemicals or unhealthy ingredients. (Fortunately transfats are not so prevalent as they were.)

I think we often forget the connection between what we eat, lifestyle issues, and our degree of health. Experimenting with symptoms can help us to track down habits, foods, or issues in our lives that are getting in the way of our health. Reaching for a pill to remove discomfort or symptoms can undermine this process, so we continue as we have been and, eventually, our health worsens to the point where we need what I consider “emergency medicine,” whether drugs or surgery.

Although a boon to the drug industry, this mandated drug benefit only encourages this reaching for a pill–and it can penalize those who choose to practice preventative and integrative health care, to work with their symptoms as warning signs to be explored. It seems that our stunning, important, and expensive array of tools in emergency medicine are extremely important for those times when we need them. Yet, it would save us all a great deal of money if we and our food industry realized how much they are an integral part of our preventative health-care system–or could be. IMHO, this should be our primary health-care mode.

As in the amusing commercials on television, pharmaceuticals always seems to have a long list of side-effects that can seem worse than the condition for which you are taking them. At least in some cases, the worst side effect of reaching for drugs to remove symptoms is that they can unwittingly encourage us to find temporary relief as we keep doing or not doing the things that caused the symptoms in the first place. Therefore we lose a valuable and satisfying way to know and work with our own unique bodies, tendencies, and capacities for change, evolution, and well-being.

By: Jeannette T.

Jeannette T. — Mon, 22 Sep 2008 21:56:51 +0000

I just found out about the prescription coverage requirement for 09, and I’m outraged. We already pay $850/month (self-employed, family) for minimum health insurance (w/$2K deductible for ea family member! so we pay for every lab, xray, blood, etc.). I prefer alternative treatments (acupuncture, chiropractic) but cannot afford them.

Now we’re going to have to use prescription drugs just to make the $150-200/month worth our while!

Does anyone know how I can fight this? I need to scream at someone (oh, maybe there’s a drug I can take…let me make an appointment, pay $20 copay plus hundreds for tests, and then I’ll get my prescription…)

By: Charlie Baker

Charlie Baker — Mon, 03 Mar 2008 05:27:25 +0000

Brian - absolutely, totally, completely right. Thanks for writing.

By: Brian

Brian — Tue, 26 Feb 2008 20:07:47 +0000

Being self-employed, the plans offered by the Connector have been a life saver in terms of keeping my family insured at a reasonable cost. If they are to mandate drug coverage, I have a simple solution I think everyone on this message thread can agree with: a bare bones/high deductible drug coverage option. If I could get such a plan for my family for around 50 extra bucks a month, that would be OK. However, a fully loaded drug coverage plan costing an extra $150-200 would be hard to swallow. At the end of the day, affordability is the key. We will have achieved nothing if the most basic plan is financially out of the reach of the average working family.

By: Charlie Baker

Charlie Baker — Tue, 19 Feb 2008 02:33:08 +0000

Folks - there was much discussion about having the plans offer a skinnier drug coverage plan design than the ones you see in typical plans designs. It couldn’t get past the folks at the Connector. If the state was willing to provide the framework to the plans to offer stepped down drug coverage, I think the plans would do so in a heartbeat. As it stands now, however, it’s going to be pretty fully loaded plan design for drugs starting in January of 2009.

By: sean grady

sean grady — Fri, 15 Feb 2008 17:01:23 +0000

Sure it would be nice to offer every person a healthcare policy with prescription drug coverage but the recent news from Massachusetts is all bad in terms of affordability of such a generous package. Most Mass taxpayers are now paying three times for healthcare: 1) Their own hefty premiums thru their employers (which are already inflated to help compensate for lower Medicare and Medicaid rates to providers and hospitals). 2) For Medicare thru the Medicare payroll tax we all pay (a program which may not even be around for younger citizens). 3) For Medicaid thru our state and federal taxes that fund this program. I think we are close to hitting a wall asking people to pay out even more for further coverage and now people want drug coverage added as well? This is not sustainable as the same group of people are paying the bills for everyone. A policy which at least gives coverage for hospitalization is a generous and important start and if they can get 90% of their prescriptions at Wal Mart, well… that’s a good start.

By: Michael D. Miller, MD

Michael D. Miller, MD — Thu, 14 Feb 2008 21:34:33 +0000

It seems that the issue really comes down to concern about driving out the marginal individual purchaser because of the increased premium cost with prescription benefits added. I believe that this marginal affordability problem should be addressed in subsidies to expand/encourage coverage with the benefit that has the best combination of healthcare value creating healthcare services/products, etc. Obviously I would include prescription drugs in that mix. To control costs (and thus premiums) you can have a formulary, prior-authorization, utilization review, step-care, just as insurers can require PCP referrals for specialist care or certain tests, etc. That makes more sense than encouraging adverse risk selection…. The goal should be to urge people into the best coverage for them, while providing options that continue to spread risk across a large group. That seems to be the reason MA delayed the requirement for having prescription drug coverage, i.e. get people covered and then bring them up to what should be a community standard benefit package.