COLUMBUS, Ohio — A new bipartisan bill introduced in the Ohio House of Representatives would prevent insurance companies from cutting off drug coverage midway through a patient’s annual plan. At this time, this is completely legal and is causing problems for many people across the state.
Weeks after being locked into a health insurance plan, Natalie Hastings was surprised to learn that her insurance no longer covered her ADHD medication.
“I was stuck trying to figure out, ‘What should I take?'” Hastings said.
Her new medication isn’t very effective.
“What was the process like when you had to go off your medication and start a new medication?” News 5’s Morgan Trau asked.
“It’s more irritating than other drugs,” Hastings says. “So, um, I forgot the rest of the question. Yeah, I literally forgot the rest.”
Hastings said he included leaving the question blank because it shows how big of an issue it is to switch drugs.
She had to switch from Mydayis, the only medication that consistently worked, to Vyvanse, which is a fortified version of Adderall.
“Even if ADHD medications aren’t in your body for a long time, that doesn’t mean the switch won’t affect your daily mood,” she added.
Currently, insurance companies are allowed to change covered drugs midway through a patient’s annual plan.
State Rep. Beth Liston (D-Dublin), who is also a doctor, thought this was unfair and introduced it. House Bill 291 Changes are prohibited after plan selection.
“Insurance companies can’t do bait-and-switch tactics with patients who think they’re getting one type of insurance and then thinking they’re going to get a completely different type of insurance,” Liston said. .
He and state Rep. Sarah Carruthers (R-Hamilton) also ensured that insurance companies don’t increase insureds’ drug costs or shift drugs to more restrictive levels of care. There is also an invoice cutout. Unless the FDA issues a statement questioning the safety of the drug, the drug is permanently discontinued, or the manufacturer removes the drug from sale in the United States, health care providers may The scope of application cannot be canceled.
The bill does not prevent health insurance issuers from adding drugs to prescriptions, the bill states.
“I think a lot of times people don’t realize the subtleties involved in making treatment decisions,” Liston added. “One drug is not the same as another, even if they belong to the same group.”
Sharona Hoffman, a medical law professor at Case Western Reserve University, explains why companies oppose the bill, even though they have personal feelings about insurance companies switching people’s medications. explained.
“To save money, you might decide that a certain drug is too expensive, or that not many patients need it, so it’s not worth keeping it in stock,” Hoffman said. To tell.
Since manufacturers can raise the price of drugs, insurers may feel they have no choice but to lower prices, he added.
“If you don’t have the authority to decide whether you can pay or not, you could go out of business,” the professor said. “To cover one person’s drugs, you may have to raise everyone else’s rates astronomically.”
Hastings and insurance companies likely would have had a hard time, Hoffman continued, as ADHD drug shortages persisted.
“If your insurance company is facing a drug shortage and you have to fight for supplies, they may say forget about it,” she says.
Hastings countered that it’s patients who are actually struggling amidst the shortage.
ADHD medications are considered controlled substances. This means that patients in Ohio typically need a new prescription for each bottle, and the doctor can only write three months’ worth of prescriptions at a time. Still, many types of meth are technically “non-refillable,” requiring patients to call in monthly to refill their drugs. On top of that, ADHD medication can only be refilled within 28 days, so many users have had to scramble to restock if their pharmacy doesn’t have the medication in stock. Once you find another pharmacy that has the drug in stock, you will need to pick up the new prescription and send it to the new location.
So not only did Hastings have to deal with switching to a different ADHD medication, but he also had to switch to a more popular and less produced drug. Additionally, her two sons also have ADHD, so it was a “disaster,” she said.
Related: Adderall shortage affects patients across Northeast Ohio
“It’s a mess,” she added.
Hoffman agreed that sudden changes in health insurance coverage could be “devastating and life-threatening.”
Hoffman has personal experience with insurance companies dropping drugs. Her husband takes medication for Parkinson’s disease, which she says is expensive. This summer, they received a letter stating that the insurance company would no longer cover this particular medication, which he had been taking steadily for years, she added. In this case, she is currently appealing this decision as there is no equivalent or similar medication for him to take.
News 5 reached out to eight of the state’s most popular health insurance companies: United Healthcare, Aetna, Anthem, Medical Mutual, SummaCare, Humana, Cigna and Buckeye Health Plan. No one will comment.
The Ohio Association of Health Plans (OAHP), a coalition of health insurance providers, did make the case that it was manufacturers who needed the price freeze.
“OAHP opposes HB 291 because health plans should be able to update their list of prescribed drugs at least once a year to control health care costs for employers and consumers.” said Gretchen Blaser Thompson, director of government affairs. “These changes are necessary when new drugs come to market, when new guidance is released from the FDA regarding potential safety issues, and when pharmaceutical companies change the price of drugs. is held multiple times each year.”
The group has proposed other ideas to improve the situation.
“OAHP proposed a simple solution to this challenge by advocating an amendment that would prohibit drug companies from changing prices while Medicare prescriptions are frozen,” the spokesperson said. continued. “I hope the House will consider this proposal to improve the bill.”
But for Hastings, the important thing is that he won’t be able to get the medicine he needs.
“You’ll be relieved to know that it’s only once a year that you don’t have to worry about what drug insurance will cover you and your family,” she says.
The bipartisan bill is expected to be debated in the coming weeks.
“If I had known my medications wouldn’t be covered, I would have chosen a different plan,” Hastings said.
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