A Collection of Problems with the US Health Care System

Disabled. North Carolina. Statement 10229.

Categories: Patient Statements
Tagged as:

State:: North Carolina

Occupation:: Disabled

I’m on Medicare because I’m disabled. I just turned 61. I’ve been taking the same medications for about 20+ years, but this January, 2016, almost all of my medications were taken off the Medicare formulary because they were deemed “high risk” for people in the Medicare “population” or “not effective”. I’m not 65, I’m not elderly. My husband, who has UHC coverage and is 64 can get the same medications on his plan, but because I have UHC Medicare I can’t have the medications anymore, ones I was just allowed to take in December.

There’s a list called the Beers List that is made up every so often by people that think they are smarter than my doctors who have gone to medical school and practiced medicine for many years. They have treated me, one for over 25 years, and I’ve had chronic illness for over 25 years. We’ve worked hard together to get medication combinations that work for me so I can function adequately given I have several painful autoimmune issues to deal with. Suddenly in January 2016 I’m faced with replacing ALL of my medications at once, not an easy thing to up and do.

In addition even the pharmacy was stunned at the proposed substitutions, like an antidepressant for an antihistamine, or an NSAID for a muscle relaxor, what are they thinking? But my favorite was when we put in an exception request for one medication that has absolutely no substitute because there is no other medication to replace it. After two hours on the phone with the lady at the insurance company, calls to the doctor, and filling out forms, it only took one half hour for a call to come denying me the medication because “it wasn’t on the formulary.” Well, duh. That’s why I was asking for the exception. It wasn’t on the formulary because Medicare deemed it “Ineffective.” Who are they to decide that? It’s the only medication that treats the medical issues, the ONLY ONE. And my doctor and I say it does work, and the FDA says it does, which is why the drug company is allowed to make the medication in the US.

My doctors have seen a sudden huge and dramatic spike in the number of requests from patients needing substitute prescriptions since January 1st. One doctor spent over 14 hours one weekend writing out exception letters because his patients meds were being denied coverage for “normally prescribed medications.”

The Affordable Care Act is messing up the lives of so many people. Just this year people are being denied care because premiums aren’t being processed properly (one friend doesn’t have coverage because she’s been told that her check was received but it doesn’t show that her premium was paid), premiums are going up (a friend’s went up $1000/month for her and her husband), medications are being denied as not being covered, co pays are being raised (my friend with MS had her Rebif go from a copay of $14/month to $1300/month and Lyrica go from $14/month to $65/month). Doctors are refusing to give out prescriptions for pain medications, some are not taking on new Medicare patients.

The ACA has ruined health care in the US. Things should have been left as they were, with a plan devised to cover those who weren’t with a plan they were required to pay for themselves. Instead those of us who have worked hard all our lives, and sacrificed a lot to have health care are losing everything we had that worked so well. The liars in Congress and the White House, and POTUS have played political games that don’t affect them, but have destroyed the health care system we had that gave us great health care at reasonable cost. Now we have less care, fewer options and greater cost. They have lied, and they will get what they want, universal, crappy health care. I’m not happy, I’m pissed. I want you and them to know that I’m wise to their scam. I want the old way back, it was my choice, it was better, it was cheaper, it was the care I needed and wanted. Keep the government out of health care.