Annual RX Maximums

[Phillip Arnn]

If this has been covered I didn't find it in search and I apologize.
The reform bill calls for the abolition of annual maximums. Does that include caps on RX?
In Texas the only large carriers that don't have an annual cap are Humana, GR if you take the upgrade, and World.

Phil

 

[dgoldenz]

Nobody knows the answer yet. Wouldn't it be nice if somebody did?

 

[somarco]

Sebelius knows. She just isn't telling . . .

 

[Norwayguy]

Sebelius knows. She just isn't telling . . .

She only knows in the sense that the bill Directs the Secretary of Health and Human Services will determine. I doubt that she has given it any thought. I would believe she would lean towards no cap on Rx because there is no down side for her...If she allows limits on Rx and someone comes up with a good sob story it can come back to bite her.

 

[TXINSURANCE]

All of this translates to fee carriers and high premium. Goes great in a depressed economy. Good job dems...

Or maybe that was the goal???
- - - - - - - - - - - - - - - - - -
Fewer carriers...

 

[jsd1239]

Sebelius knows. She just isn't telling . . .

Wasn't Sebelius an insurance commissioner in Kansas. She should be right on top of everything. Of course she hasn't read it yet.

Remember what Pelosi said "We have to pass it to find out what's in it". It passed and we still don't know much more then the day it was passed.

 

[somarco]

I doubt that she has given it any thought.

Therein lies the problem. Nothing was given any though. Hard to believe this woman was Insurance Commissioner and apparently learned nothing about the industry she regulated.

But then, we have a Supreme Court nominee who has never practiced law in a courtroom so I guess this us just quid pro quo.

 

[STIBROKER]

Rob Liano will take care of it and let us know......

 

[Crabcake Johnny]

It's tough to decipher but the caps affect "annual" caps. For health insurance agents "annual caps" only applies to the policy lifetime max. It not does apply to certain benefit limitations but we'll see how HHS interprets the language.

In in fact they tell the carriers that no benefits can have limitations, we're talking about DME, RX, in-outpatient therapy, etc...they'd have no choice but to pull out of the market.

 

[djs]

The answer is simple.

Drug companies helped promote and pass this bill. They didn't spend that kind of money to have a cap on the returns they will get.

I'm guessing, but I don't think its a stretch to say that there won't be caps on Rx. You might find some strange language around the use of generics though.

Dan