Sick Find Key Drugs Missing From ObamaCare Plans

AIDS, cancer meds could cost patients thousands each month
By Kevin Spak,  Newser Staff
Posted Dec 10, 2013 10:44 AM CST

(Newser) – Thanks to the Affordable Care Act, heath insurers now can't turn away sick people. That's the good news. The bad news: They don't actually have to cover the drugs those patients need. Key drugs are missing from some plans, the Washington Post reports, in what patient advocates believe is a bid to drive sick customers away. Some plans omit certain medicines for HIV, cancer, multiple sclerosis, rheumatoid arthritis, and more altogether, or else require patients to pay as much as 50% out-of-pocket—which is often more than $1,000 a month.

Consumers might not realize, either; some plan don't detail their formulary (that's the list of covered drugs) until patients formally apply, the Wall Street Journal reports. And, as Scott Gottlieb at Forbes explains, if a drug isn't on the formulary, it won't even count toward your out-of-pocket cap ($12,700 for a family, $6,350 for an individual). The Obama administration says that if your plan doesn't cover a crucial drug, you should ask for an exception; the government is asking insurers to respond to these requests within three days. (Read more ObamaCare stories.)

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