jlf1961
Posts: 14840
Joined: 6/10/2008
From: Somewhere Texas
Status: offline
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quote:
ORIGINAL: defiantbadgirl
Who the hell gives health insurance companies the right to stop paying for diabetes medications that work so people have to switch to medications that don't work? Why isn't this illegal since driving with out of whack blood sugar is dangerous and can cause accidents? Just when my father gets on medications that all work together, the stupid insurance company stops covering a certain medication, he has to take something else, and his blood sugar skyrockets. He lives in a small town and some of the specialists he drives to see are an hour each way. He's always telling me keeping blood sugar controlled is crucial to preventing blindness and limb amputations, but how's he supposed to do that when the insurance company keeps making him switch his meds? Is there anything he can do to get them to knock it off?
Without knowing just what medications your father was on, or was changed to, it is difficult to understand the reasoning behind the change of policy.
However, you, actually your father, has the right to contact the insurance provider and ask for a medical justification for the change.
As for reasons an insurance may change what they will and will not pay for is varied, and not just based on the bottom line.
As older medications are usually cheaper, a change to a different medication is not usually based on cost savings. The newer medication could have less chance of side effects, where as the older medication has a higher risk.
My mother had MS, and complications from that condition contributed heavily to her death in 2008. During her years of treatment, medications were changed at the insurance company's discretion. I usually contacted the insurance carrier to ask why, and it never failed that I would get a packet with a cost analysis, information on the new medication which was the same that went into the PDR, and a bunch of other information.
True, sometimes the covered medications changed for cost reasons, however, the insurance company never forced a medication change to an inexpensive medication if there was not some other benefit to the patient.
In fact it would be foolish for the carrier to do so, since any complications of a lesser quality medication is going to eventually lead to a hospital procedure that is going to cost a lot more than keeping the old medication in the coverage list.
Add to that there are Government regulations that actually do make the practice illegal, and in place long before obamacare.
The only drugs or treatments that a carrier can refuse to cover are those that are still considered experimental, or the long term benefits are unproven.
My suggestion is to contact the insurance company, ask for a written statement as to what the reasons for the change were, and then check the effectiveness of the new medication against the old.
There is one thing you should know about diabetes, what may be working this week may not work next month or next year. The longer you are on a medication, the less effective it is.
Before you scream foul, make sure you have valid grounds, and if so, contact a lawyer. Class action suits against insurance companies are winnable, and the legal fees the lawyer gets can easily place him or her in a much higher income bracket.
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