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A Lesson Learned in the 2015 Open Enrollment Period

And that is, prescription drug costs can jeopardize the American health care system.

With the ending of the Open Enrollment Period, I am just now finding time to share my experience of guiding my clients through this period during the last 6 months. Based on the policies I have written for my clients, I have made some observations of the cost of prescription drugs. These have outraged and shocked me.

During the first three days of the open enrollment period, I had two clients who’s combined prescription drug costs for one year exceeded $300,000.  I question how any medical system could sustain this? Imagine if 1000 insurance brokers each had two clients like mine — that would mean that the American health system spends more than $300 million on prescription drugs for 2000 Americans each year. It is reasonable to assume that far more than 2000 Americans will have the medical treatments necessitating these expensive drugs.

We are faced with a major dilemma-  as groundbreaking improvements in medical treatments are being made, we are also being hit with the huge costs of the prescription drugs that often accompany those treatments. Examples of the impressive improvements in medicine include complicated spine surgeries, transplantation of organs such as the liver, heart and lungs. These mark incredible progress, however, the cost of the prescription drugs for these types of procedures is out of control.

The costs of prescription drugs are embedded in the health plans of people under the age of 65. So, as insurance brokers, we only see those specific costs in the policies that are written for those age 65 years and over. We assist seniors to find a suitable prescription drug plan based on their individual medication usage.

With the implementation of the Affordable Care Act (which has very generous benefits at the platinum level), the financial burden for these drugs is moved away from the sick American onto the insurance carriers and the individual states/federal government. Any insurance carrier can tell you that people with pre-existing health conditions would be moved to the Platinum plans of the various carriers. While they pay higher premiums, the maximal exposure is in most cases only $4000. Seniors on Medicare (in which the Part D prescription drug portion is separated from their medical care policy), actually carry a heavier load of cost sharing on prescription drugs than the Americans under 65.

It is important to note that the costs for many of these identical drugs are a fraction of what we are charged in the United States in other countries, such as Canada and India. We are living in a global society; why do Americans have to carry the load of the cost and why is it illegal for Americans to obtain the same prescription out of less expensive countries?

Doctors, hospitals and insurance carriers are trying to talk to the politicians in Washington to get them to change the system. But with politicians heavily funded by the lobbies of the pharmaceutical industries are they really willing to change anything ?

The greed of the pharmaceutical industry is breaking our American medical system. Politicians have to find a way to regulate the of cost of prescription drugs, or allow us to buy expensive drugs in other countries. Otherwise the American Health System might simply fail one day.

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