You Cant Keep Your Medication, Either: More Obamacare Issues RevealedLily Dane Prescription drug coverage or the lack thereof is the latest unpleasant surprise consumers will face courtesy of Obamacare. Heres how prescription drug coverage works under Obamacare. Under the ACA, prescription drug coverage is one of 10 essential benefits. This means that all plans are required to cover at least one drug in every category and class in the U.S. Pharmacopeia, the official list of approved medicines. Many drugs will not be covered at all, and if a consumer needs a certain medication and pays cash for it, the cost wont count against out-of-pocket caps. Lists of drugs that plans agree to provide some coverage for under Obamacare are called formularies. Dr. Scott Gottlieb explained how this works in an article for Forbes: As the Wall Street Journal recently reported, these co-pays can already be substantial, pushing people quickly to their annual out-of-pocket limits $6,350 for individuals and $12,700 for families (after which insurers pay the full tab). Take, for example, the drug Copaxone for multiple sclerosis. If you buy the highest cost platinum plan, the out of pocket costs drop to $792 a month. But youre probably better off with the cheaper bronze plan anyway. Since youre going to hit your out of pocket cap regardless of your plan, you might as well save money on the premium (which doesnt count against your deductible or out of pocket limits) and race to the $12,700 spending cap as quickly as your family can. After all, the provider networks (and formularies) used by low cost bronze and high cost platinum plans are often the same. The only thing that varies between different metal plans is typically the co-pay structure. Why pay higher premiums just to lower your co-pays when youre going to hit the out of pocket caps anyway. By purchasing a costlier, gold or platinum plan, you typically cant buy up to a higher benefit. What youre really doing is just prepaying the cost sharing. In Dr. Gottliebs example, the drug Copaxone was partially covered under the plans formulary. But what if a medication is not covered under a plans formulary? The out-of-pocket caps only apply to medications that are covered on a plans formulary. This means that if a patient needs a drug that is not listed in their plans formulary, they may have to pay for the full cost of the medication. To add insult to injury, the money they spend wont count against their deductibles or out of pocket limits ($12,700 for a family, $6,350 for an individual). So, how does one find out if the medications they are currently taking are covered under Obamacare plans? It isnt easy in many cases, the Obamacare exchanges dont make their formularies accessible by a simple click on the website. In some cases, the information doesnt seem to be available at all. The Washington Post explains: In other words: good luck finding accurate information. If a drug you take is not on your plans formulary, your doctor can ask the insurer to make an exception and cover it, and if that request is denied, you can use your states appeals process to seek coverage. If those routes dont work, wellyoull have to pay out-of-pocket or change medications. Finding a good drug plan under Obamacare will prove difficult, as Dr. Gottlieb explains: Its difficult. Generally speaking, the benchmark plans that are part of the Federal Employees Health Benefits Program have the best drug formularies, some of the large HMOs, the worst. In many cases, states benchmarked their Obamacare plans to state employee health programs, which usually fall in the middle. But there is a lot of variability. For example, when it comes to costly, molecularly targeted cancer drugs, some benchmark plans cover 11 drugs, but other plans cover as few as seven. I found one plan in North Carolina that doesnt cover Actonel for osteoporosis, Aubagio for multiple sclerosis, or Xeljanz for severe rheumatoid arthritis, among other non formulary drugs. In California, a state that Obamacares architects are holding up as the model of success, some of the major exchange playersincluding Anthem, Blue Shield of California and Health Nethave posted their exchange formularies on their websites. Unfortunately, theyre not easy to find and incomplete. As another excellent analysis finds, a lack of standardization and on-line tools makes it hard for consumers to compare between plans. Some of the published lists do not show all of the covered drugs. For instance in California, Blue Shields document states that only the most commonly prescribed drugs are shown in its published formulary. Anthems published list is also not comprehensive. Some analysts have tried to look across the plans, but comparisons are as hard for experts to make as they are for consumers. If your medications are listed on a plans formulary, you still may have to pay dearly for them: Nancy Pelosi infamously said, We have to pass the bill to find out whats in it when referring to the ACA. Apparently, that applies to the plans themselves as well as the law: consumers wont know if their doctors, hospitals, and now their prescription medications will be covered on plans offered through the exchange. Lily Dane is a staff writer for The Daily Sheeple, where this first appeared. Her goal is to help people to Wake the Flock Up! 