Prescription Drug Coverage Under Obamacare —Do You Need to Worry?

In 2013 some Americans will start choosing health insurance plans offered by the new state-run health insurance exchanges. Designed to lower prices and increase competition, the exchanges will surely help millions of people access affordable care. However, health insurance plans often do not adequately cover prescription medications, and we are eager to follow the effectiveness of the exchanges as applied to prescription drug pricing.

While we hope (and believe) that increased coverage will enable more Americans to take needed medications, we believe that many will not benefit from the increased coverage. The Obama administration’s loose guidelines pertaining to prescription drugs and essential health benefits mandate that they require only one drug per class – in other words one statin (to treat high cholesterol), one proton pump inhibitors (to treat GERD), one inhaled steroid (to treat asthma), and so on, must be covered.

For many this will not be a problem. If there is only one prescription you plan on taking, you should be able to find a plan that covers it. If, however, you are taking multiple medications, things could get a bit hairy. Just because two drugs are in the same class doesn’t mean they work with the same efficacy for a given person. For example, atorvastatin (generic Lipitor) may work better for cholesterol treatment than simvastatin (generic Zocor) for one person, and vice versa for another. Imagine how difficult it would be to find an insurance plan that covers all your drugs if you are on three or four medications!

Some states plan to address this potential problem by requiring that plans offer more extensive drug coverage. As of October, 2012, an analysis of eight benchmark plans shows that they cover about 62% of drugs available in different classes.

While the health insurance exchanges are meant to provide a competitive marketplace that lowers costs, it isn’t as simple as just choosing a plan that covers the most drugs. You need to make sure it covers your drugs (in addition to other specific health benefits). We hope that the insurance exchanges will help end America’s $317 billion prescription non-adherence problem, but we fear that the pharmacy coverage under Obamacare won’t be nearly enough.

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7 Responses to “Prescription Drug Coverage Under Obamacare —Do You Need to Worry?”

  1. When I had insurance with prescription drug coverage, the insurance company limited triptans to 4 a month. That is how I found pharmacy checker. Even buying from Canada the prescription was still almost $100 a month on top of what I paid for insurance coverage. With no insurance, the drug company covers it for free. Stupid.

  2. tweetytude says:

    I need to take warfarin which like insulin is a medication which is variable, meaning I require regular testing and adjust my medication accordingly. To do this I keep more than one strength on hand. I have been on this for 40 years I have been arguing with the insurance companies for years about it. Now I’ll have pencil pushing bureaucrats to argue with. TERRIFIC!

  3. Tom Taylor says:

    Does Obamacare prohibit purchasing drugs from Canada ???

    • Hi Tom,

      Obamacare, the Patient Protection Affordable Care Act, does not affect prescription purchases from Canada. The FDA’s policy is that they do not prosecute individuals for buying medication from Canada and other countries for their own use, and have never done so, but the practice is under most circumstances technically illegal. If you’re buying medication online from Canada or other countries it can be safe when the online pharmacy is approved by a third-party, such as PharmacyChecker.com. You can view a list of some of our approved pharmacies here.

  4. Kmfron says:

    I have been told that the only place to get “full coverage” prescripiton’s filled with be at Wal-Mart-Sam’s Club. I have been told that this huge complany worked a deal with Obamacare to be the sole full pay provider for prescriptions. In other words, you can go elsewhere but with the 6-10,000 deductible you will be paying 100% of the prescription, doctor visits etc anyway, plus the 500-1500 dollar a month fee for a whole lot of nothing. What is the truth here?

    • Susan Moore says:

      the deductible is not used for doctors visits and prescription drugs. Only for emergency rooms and hospital stays is when the deductible is applied.

  5. Great! One more thing to worry about in addition to my doctors not being in the new network!!

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