US health
insurance companies who cover high-priced prescription drug coverage should be
able to pressure pharmaceutical companies into reducing their costs, but they
don’t. These are sometimes covered by
Medicaid in each State. This is most common where the patented version of the
medicine works, but the generic version doesn’t work.
The
health insurance companies are liable for higher cost medical treatments that
are needed when effective prescription drugs are denied.
The
Pharma companies claim that they charge unaffordable prices for these drugs in
order to pay back their research costs. This might work for wealthy patients,
but it doesn’t work for indigent patients. If the patient needs to take 2 pills
per day or 720 pills per year and the price per pill is $10, the annual cost of
this medication is $7,200 per year.
Doctors
are spending time arguing with insurance companies and patients who can’t get
the prescription medications they need will end up in hospitals and bills in
excess of $100,000.
The way
for an indigent patient to get Medicare Part D Prescription coverage is to ask
for a “Special Needs Plan” from Medicare and sign up for Medicaid in their
State. This is done by insurance brokers accessible on insurance company
websites.
Insurance
is a “cash-flow” mechanism and the price is based on risk. Health Insurance Companies build a 30%
“reserve” into the premium. They estimate the “maintenance cost” of
pre-existing conditions to historical, statistical risks and add 30%.
The best
insurance is self-insurance. Ensuring
that your spouse can be self-supporting in the event of your death or
disability is basic. Most insurance can be replaced by “net worth”. Cash
reserves should pay for routine maintenance of your house and cars.
Norb
Leahy, Dunwoody GA Tea Party Leader
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