Insurers Are Refusing To Pay For Some Common Medications: NPR

Filed Under: Costs, Health plans, Patients

Summary: “Express Scripts and its rivals including CVS/Caremark and OptumRX manage prescription drug coverage for insurers and employers,” Alison Kodjak writes over on NPR. “They’re trying to spark price wars among drugmakers by refusing to pay for some brand-name medications unless they get a big discount. The result is that average costs for many drugs are falling. At the same time, consumers are being forced to change medications, sometimes to brands that don’t work as well for them. Tim Kilroy is a father of five who runs a business out of his home in Arlington, Mass. Kilroy has attention deficit hyperactivity disorder — ADHD — and he is dependent on his medications to keep his mind, and therefore his business and family life, in order. … He spent six years trying medications, adjusting doses, switching and starting over before he and his doctor settled on a long-acting form of Ritalin. He’d finally landed on the drug that worked for him. But about a year ago he switched insurance and the new pharmacy benefit company — United Health Care’s Optum subsidiary — refused to pay. ‘I thought, “How dare you,” ‘ Kilroy says. ‘How dare this company that I pay money to tell me how to manage my health care. I was really, really angry.'” Alison Kodjak, “Insurers Are Refusing To Pay For Some Common Medications,” : Shots – Health News : NPR.