My spouse struggled with a medical condition for years and was lucky to finally get a prescription for something that actually resolved the problem. The medication was expensive ($1000+ a month), but since we literally tried everything else, insurance would “let” it be covered.
Then I lost my job and had to move over to a new company’s insurance plan. And they won’t cover it.
The fact that your employment in the US determines what medical care you can get is absolutely bonkers.
A medication being more expensive usually indicates rarity. This means the instance of required coverage by insurance companies is also rare. The fact any medication, needed to mitigate the risk of simply being born, might not be covered by “insurance” is bonkers.
I think we need to start a new industry to take it to insurance companies every time they deny coverage. Bury them in complaints and legal actions. Go so hard on every case that they give in immediately upon seeing the letterhead.
My medicine is $1,500 a month without insurance. It’s a bipolar medication. It doesn’t indicate rarity, it indicates greed. They could easily sell it for half the price and still make money.
I knew a guy with AIDS that had some pills to take like once a month I think that were around that price and also struggled with coverage. I didn't think AIDS was considered rare.
It’s important to keep in mind that this rarity is often artificial scarcity by the pharmaceutical companies. There are some conditions which are rare, but have treatments that have been available for decades now with generics on the market for years. They simply don’t produce much of those meds, even though it’s cheap to do so, in order to artificially inflate the market price.
Insurers are complicit in this scheme because they don’t push back on this practice at all. Without single payer, we have no negotiating force to get pharmaceuticals to produce drugs in an affordable way, so they can manipulate the market however they please. It’s absolutely depraved.
That's their point. If I need to setup a production facility but there's only demand for a thousand doses a year, then the long term capital costs are going to drive the unit price up.
But there's also greed. Stuff that's a dollar to make and a thousand dollars to use.
They did that to prevent people from being able to shop for insurance. They promote capitalism, but they suppress competition which is, in theory, supposed to be part of a "healthy" capitalist economy.
The ACA helped a tiny bit, but it didn't go nearly far enough. And then they tried a zillion times to revoke even that.
It's never been about healthcare, it's always been about making a small number of people very wealthy.
Seriously. My wife lost her job because of medical conditions (depression and adhd) before we were married. Getting her treatment was part of why we got married