As regular readers of this site know, I have pretty good health insurance (for an American) for everything except prescription drugs. My prescription drug coverage is a joke. My insurance, which I pay around $580 a month for, covers 90% of my medical bills, I pay 10%, but it only cover $1,500 a year in prescription drugs, which, as my mom warned me, become a bigger part of your life the older you get.
(I only found out a few years ago that my insurance always did, and always will, pay only $1,500 a month for prescription drugs – there’s no inflation multiplier, nothing.)
When I was in my 30s, my prescription drugs costs were minimal. Now that I’m approaching 50, they’re quite large and growing. My allergy/asthma drugs alone, which I’ve documented repeatedly on this site, have cost me up to $550 a month, which comes to $6,600, a tad more than my $1500 allowance from Blue Cross Blue Shield.
Big Pharma charges far more in the US than they do in Europe for the same drugs
Because of the high cost of those drugs, I’ve been buying many of my asthma drugs in France for several years now. The same drugs, made and sold by the same drug companies, go for up to 1/5 the price in France. Why? Because the French government negotiates drug prices with Big Pharma, so the drug companies simply charge the Americans more to make up the difference.
What’s more, I found out this summer that those same drugs now cost 10% cheaper in France – the drug companies lowered the prices after several years of keeping them flat in Europe. In the US over that same period, Big Pharma raised the price of the same drugs 36%. They’re now almost 5 times as expensive in the US as they are in France.
And you wonder why we have health care budget problems in America. The system is made for gouging everyone with ridiculously high prices.
But now something has changed. And I may no longer have to buy my prescription asthma drugs in France. Why? Obamacare.
Obamacare puts an end to annual limits
One of the things Obamacare did was tell insurance companies that they can no longer sell new policies like mine, that put an annual limit on how much they’ll pay for prescription drugs. Those limits are almost phased out this year, and will be phased out completely next year FOR NEW POLICIES. (nder Obamacare, you can keep your old policy, but you won’t get all the new protections like this.)
Last year, I checked the various PPO options that BCBC offered, to see if I could get anything to better cover my prescriptions. I pretty much had to stick with a PPO because I can keep my own doctors, but also it was the only “safe” way to change plans – if I moved to an HMO plan, I believe they would have considered me as applying for a “new” plan, charged me more, and possibly turned me down (pre-Obamacare). Since I was staying in the same family of plans, I could switch without any headache.
Anyway, the only PPO plan that would provide me unlimited prescription drug coverage, and at the same time give me my 90-10 co-pay, with my $100 deductible, was a plan costing a good $200 more per month, or $2,400 more per year. And I don’t really have that kind of extra cash available, especially when I’m already paying $580 or so a month in premiums.
So, I’ve been buying my drugs in France and hoping that I don’t come down with some disease requiring expensive prescription drugs (like MS or HIV, each of which can cost you several thousand dollars in Rx drugs per month), and if I did ever come down with them, I figured I’d have to move to Europe (or Canada) for good.
Then, this year, my asthma doc said he wanted to start cutting back on the steroid drugs we’re using to control my asthma. Long-term steroid use is not terribly good for you. So I checked on the price of the various replacement drugs. One is potentially in the ballpark of several thousand dollars a month, though if it’s considered a medical treatment, and not a drug, I might just have it covered by my insurance (though I suspect they’ll still find a way to say no at that price). The other is a prescription drug, and costs a little over $1,000 a month. Which is insane. But, my only other option is staying on steroids and looking forward to a future of other medical problems from prolonged steroid use. So I went back to the BCBS Web site and decided to look at the plans one more time. And what do you know…
Suddenly there’s an affordable plan to cover my prescription drugs
This time I found a plan that is different from my current PPO in three ways:
1. The deductible goes up from $100 a year to $300 a year. I can live with that.
2. There’s no annual limit on my prescription drugs. I can definitely live with that.
3. The price of the plan is only $25 more a month than I currently pay. I can live with that too.
So, for $500 more a year, I can finally get my prescription drugs covered.
Now, let’s not fool ourselves. I’ll still be paying $611 per month for health insurance, which is ridiculous. Tell a European you pay that much for insurance and they’ll gasp in horror. And, yes, I’ll be paying “more” for insurance under Obamacare. If you add the increase in the monthly premium and the additional $200 to the deductible, it comes to 7% more that I’ll be paying for my health insurance. But it’s not that much more – I can afford the difference – and more importantly, I’m only paying more because I chose to pay more in order to finally get the prescription drug coverage I couldn’t get before Obamacare.
Oh, and instead of paying that extra $500 a year, how much was I spending each year in France on my medical tourism? About $500.
This is a rather big deal for me. And if I’m lucky, the prices might even be better in the health exchanges.
Either way, Obamacare, though it’s much less “change” than I wanted, and still doesn’t do nearly enough to address the obscene prices Americans are charged for health care – and I’m still finding it awfully difficult to understand any of these details of how this law is going to work – seems to have cured my prescription drug coverage problem. And that’s no small deal.