Health Care Reform or Screwing Over the Little Guy

Come 2011, you will no longer be able to get your OTC drugs reimbursed from your Flexible Spending Account or your Health Care Savings Account.  This is the big reform we were promised by Obama.  Well, I have to say, THANKS FOR NOTHING.  I’ve been getting my OTC drugs reimbursed for years.  Why?  Because my health insurance doesn’t cover OTC medications. 

As more and more drugs follow the path of going generic and then OTC, physicians are willing to write fewer and fewer prescriptions for medications.  Insurance companies have been directing them to point patients to the growing body of OTC drugs so that health insurance doesn’t pay for them.  None of this has resulted in a decrease in my premiums, mind you.  I have access to fewer and fewer drugs. 

Worse yet, the newer drugs on the market aren’t part of my health plan’s “formulary”.  What’s a formulary?  Well, now….   You see, my insurance company has taken it upon themselves to create a list of approved drugs for almost every health condition you can imagine.  And guess what…  a surprising number of them are OTC.  Since they’re OTC, my health plan doctor is *required* to have me take the OTC version of the medication.  My insurance, and most other health plans, won’t pay for me to have a prescription filled for a drug that’s available OTC. 

That was where the Flexible Spending Accounts and Health Care Savings Accounts were life savers.  Necessary medications that were not otherwise covered by health insurance would be reimbursed.    Now that they are dropping the reimbursement for this, I am effectively without any coverage for my medication. 

In this case, that means that Zyrtec – my allergy medication – will effectively no longer be covered.  It also means that my Alleve – required for my arthritis – will also no longer be covered.  And since I take Alleve, I also must take an acid reducer – which you guessed it – is also now no longer covered as it is also OTC.  Thank you for nothing!!! 

Zyrtec tablets – $20/month
Zyrtec eye drops – $15/month
Alleve – $15/mo
Prevacid – $29/month

That’s $80 per month or $960 a year in OTC medications.  These are already things that are not covered by insurance and now they won’t be covered by my HSA either! 

Let’s take a bit more extreme example – a friend of mine who has asthma.

Primatene Mist – $30/month (1.5 inhalers)
Claratin – $44/month (control the allergies, and you help control the asthma)
Fish Oil – $15/month (helps to alleviate inflammation as well as the high cholesterol caused by the steroids he takes)
Pepcid – $20/month
Allacon eye drop – $8/month

That’s $113/month in OTC drugs or $1356 year in stuff that will no longer be covered by anyone.  He’s just left to eat those expenses.