Wednesday, October 16, 2013

The Affordable Care Act and specialty drug tiers

This may not be a popular opinion, but I'm thankful for the Affordable Care Act. While there are many parts of the ACA I don't like (the entire exchange system, or penalizing people who don't have insurance), there are some parts that will benefit Fiona. Before the ACA people like Fiona could be dropped from their health insurance for no reason other than the cost to treat them. They could be denied health insurance because of a pre-existing condition. They faced yearly and lifetime caps. This is huge when you consider the cost to treat Fiona from birth to two years will be enough to pay for a nice house. Over the course of her life it will easily exceed the average lifetime cap of 2 million. We are so lucky that we never had to worry about any of this.

What we have to worry about now are specialty drug tiers. In the past there were three tiers, low cost, moderate cost, and higher cost. Insurance companies are starting to add a fourth and fifth tier that are paid with co-insurance rather than a co-payment. That means patients who need these drugs will pay a percentage of the cost instead of a fixed cost. For patients like Fiona this cost will be substantial and unaffordable. There is no generic for igg.

Healthcare reform hasn't really made healthcare affordable, but it offers Fiona some protection. I think we have a long way to go.

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