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Prescription Drug Costs UP 33 Percent This Year

Prescription Drug Costs Up 33% in One Year

What’s Driving the Increase and How it Impacts Our Rate Filing

Date: 09/04/2015
In a climate of sharply higher health care costs under the Affordable Care Act (ACA), one number stands out: 33 percent. That’s how much prescription drug costs under ACA coverage rose in one year, according to a review of Blue Cross and Blue Shield of North Carolina’s (BCBSNC) claims data.

This data from our ACA line of business shows that prescription costs went up more than any other category of medical care in the first half of 2015. The rise in drug costs also outpaced hospital inpatient and outpatient care, as well as doctor visits.

Click here to read more about what’s driving this increase and how it impacts our rate filing.

 

Unintended Consequences of Health Care Reform

With a law as complex as the Patient Protection and Affordable Care Act (PPACA), unintended consequences are always a concern.  Last week The Wall Street Journal reported that the physician community is witnessing the emergence of a significant unintended consequence — since tax-advantaged flexible spending accounts can no longer be used to pay for over-the-counter medications without a prescription, under the law, many patients are now visiting their doctors expressly for the purpose of getting new prescriptions for the OTC medications.

The change in the law was meant to discourage wasteful spending on some health products and raise revenue. Instead, critics say the provision is driving up health care costs. Unintended consequences of the health care reform law is an area of focus for all insurance companies, and will continue to urge flexibility in the implementation process to help address potential unintended consequences.

People who have High Deductible Health Plans in conjunction with a Health Savings Account, are acting similarly.  They can no longer deduct their over-the-counter medications as a “qualified medical expense”.  Consequently, they too are getting prescriptions for OTC medications.  However, because the insured pays for his own drugs, at a discount, the effect is minimized.

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A Tip For People Who Are Planning Surgery

Here is a tip that will help you to work with your insurance company better.   Here is what happened to me.  I have an HSA type account with a maximum out of pocket of $2,700.00

Recently, I needed surgery done.  When the surgeon asked if I would pay an approximate cost before the surgery, I did it.

I paid him $2,700 up front.   He didn’t want to wait for Blue Cross to pay him.  I didn’t think that this would be a problem.It certainly was a problem!   Blue Cross and Blue Shield of North Carolina does not have any notification that I have paid the doctor directly.  Therefore, the calculation of deductible was thrown out of balance.  I ended up having to do a spreadsheet of each lab, anesthesiologist, hospital, assistant surgeon, and any one that was involved with this surgery.

Because Blue Cross couldn’t have known that I had already paid my deductible, the auxiliary providers, including the hospital were not paid properly.   This was an accounting nightmare.

The bottom line:  If the doctor asks you to pay up front so that he doesn’t have to worry about getting paid in a timely manner, don’t do it!  

Just say no. 

The doctor may warn that he won’t perform your surgery, but if you time it right, he will do it.  (“Timing it right”is waiting until it is close to your actual surgery date.)  

He is only requiring you to agree to pay so that he won’t have to wait for the insurance company to pay.  If you sign, the doctor will have no incentive to help you get him paid by the insurance company.  Don’t sign!

Do You Have Surgery Scheduled? Take This Tip

Here is a tip that will help you to work with your insurance company better.   Here is what happened to me.  I have an HSA type account with a maximum out of pocket of $2,700.00

Recently, I needed surgery done.  When the surgeon asked if I would pay an approximate cost before the surgery, I did it.

I paid him $2,700 up front.   He didn’t want to wait for Blue Cross to pay him.  I didn’t think that this would be a problem.It certainly was a problem!   Blue Cross and Blue Shield of North Carolina does not have any notification that I have paid the doctor directly.  Therefore, the calculation of deductible was thrown out of balance.  I ended up having to do a spreadsheet of each lab, anesthesiologist, hospital, assistant surgeon, and any one that was involved with this surgery.

Because Blue Cross couldn’t have known that I had already paid my deductible, the auxiliary providers, including the hospital were not paid properly.   This was an accounting nightmare.

The bottom line:  If the doctor asks you to pay up front so that he doesn’t have to worry about getting paid in a timely manner, don’t do it!   Just say no.