Yo Yo - I am guessing you work in insurance? Or wait, maybe medicine?
I am RELIEVED to hear that you think the ACA is here to stay but — as someone who had to hear “Benghazi” for about FOUR freaking years after the attack — you and I both know that this is a red meat issue that many “people” (and I use that term loosely) may be looking to make their careers on.
I would love to hear your prediction on what is going to shake out with prescription benefit managers.
I’m an uber boring lawyer in the healthcare space. I don’t have a lot of confidence in what will happen with potential changes to Medicare/Medicaid or regulations on the industry writ large.
But I am confident that the ACA’s protections for pre-existing conditions aren’t going anywhere. Even if Republicans in Congress re-codify the protections into something that can’t be called “Obamacare” (that’s really the stick in their craw, IMO), their own constituents have gotten so used those protections and are hell bent on keeping those protections. I say this as a lifelong Democrat, it would be political suicide for Republicans to nuke those protections. They’re here to stay.
Not sure what you mean by “how things will shake out with PBMs,” as that’s an entirely different and amorphous subject that would take a semester to explain. PBMs don’t determine medical coverage, they’re an administrator of the plan’s prescription benefits. Biggest issue with them right now is drug price fixing, and that’s different from insurance coverage on the whole. But the incoming Admin doesn’t seem too interested in dealing with that.
But back to the point here, and comments made in this thread. Attempting to compare coverage for a particular medication, like a GLP1, with denying insurance coverage on the whole for a pre-existing condition or conduct, is like comparing apples and hand grenades. And scaring people into not being honest with providers out of irrational fear the insurance companies will deny coverage for resulting medical conditions is just… silly. It’s also dangerous. It will result in misdiagnosis, ineffective treatment, unnecessary tests, negative drug interactions, medically unnecessary and counterproductive prescriptions, and more.
And anyone thinking they can just read test results themselves has a fool for a patient. ChatGPT ain’t your doctor. And what happens when you need treatment for whatever ChatGPT tells you, and the only explanation is the peptides? You think your doctor is just gonna think you’re a medical mystery? Nope. You’re back to square one. And if your plan can prove that you caused them to incur unnecessary costs as a result of your intentional omissions, in theory, they could seek subrogation against you for those costs. Not smart.
On top of illicit drugs, tens of millions of people, probably more, take supplements, herbs, vitamins, peptides and other things that aren’t FDA approved. Does anyone think that someone who takes iron supplement pills, Vitamin A or D, or black cohosh, each of which are not FDA approved and can be toxic in the wrong amounts and show up in blood work, will be denied insurance coverage? No. Peptides are no different.
“I’ve been shooting up heroin with dirty needles and caught HepC, and felt so invincible that I jumped off the roof and broke my back.” That guy is still getting medical coverage for HepC and his spinal surgery and PT despite his illegal and epically stupid conduct.
Shoot, you could take a daily dose of bleach to “clean out the virus from the inside out,” something clearly not meant for human consumption, and you’re still gonna have insurance coverage. It just might prompt an alert from the CDC that idiots still won’t listen to…
