General Discussion

Omaha Steve

(99,705 posts) Sat Dec 26, 2015, 11:33 PM Dec 2015

Court: Iowa insurer must pay claims for life-saving drugs (more than $1 million a year per patient)

Obamacare didn't do all it should have. Single payer now.

http://www.livewellnebraska.com/health/court-iowa-insurer-must-pay-claims-for-life-saving-drugs/article_a9c5208a-c55a-5734-9174-7992dd75b9b3.html

Posted: Saturday, December 26, 2015 12:30 am
IOWA CITY (AP) — Iowa’s largest health insurer improperly refused to reimburse a pharmacist for expensive life-saving drugs he dispensed to patients with a rare blood disease, an appeals court has ruled.

The insurer, Wellmark Blue Cross and Blue Shield, searched for a proper reason to deny claims for drugs used to treat hemophilia, an inherited condition in which patients suffer excessive bleeding, the Iowa Court of Appeals ruled this week. When that failed, the court said, Wellmark breached its contract with Iowa City pharmacist Michael Stein by refusing to reimburse him for 114 valid claims for drugs dispensed to 24 patients around the country, mostly children.

The medicine at issue is injected by patients at home so they don’t bleed to death. The drugs can cost more than $1 million a year per patient.

Wellmark, which is based in Des Moines and insures some 2 million people in Iowa and South Dakota, said it disagreed with the ruling and would appeal to the Iowa Supreme Court.

FULL story at link.

8 replies

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Court: Iowa insurer must pay claims for life-saving drugs (more than $1 million a year per patient) (Original Post) Omaha Steve Dec 2015 OP

Wow one mil a year...That is insane. Egnever Dec 2015 #1

Yeah, it makes me wonder what was going on TexasBushwhacker Dec 2015 #4

This is why we need single payer now!!! The for profit healthcare we have onecaliberal Dec 2015 #2

Don't disagree on single payer, but it alone won't take profit out of healthcare. Hoyt Dec 2015 #3

GWB's Medicare Part D doesn't allow bargaining TexasBushwhacker Dec 2015 #5

Actually, the insurance companies that handle Part D can, and do bargain. It's traditional Medicare Hoyt Dec 2015 #6

when is law gonna fix drug prices? pansypoo53219 Dec 2015 #7

It's time for congress to crack down on pharmaceutical companies! B Calm Dec 2015 #8

Egnever

(21,506 posts)

1. Wow one mil a year...That is insane.

Reply to Omaha Steve (Original post)

Sat Dec 26, 2015, 11:35 PM

Dec 2015

TexasBushwhacker

(20,211 posts)

4. Yeah, it makes me wonder what was going on

Reply to Egnever (Reply #1)

Sun Dec 27, 2015, 12:07 AM

Dec 2015

Per the article, this pharmacist used a wholesaler from Florida called FHM. Wellmark (the insurer in this case) as well as other insurers, quit paying for drugs from FHM and they went out of business. Well mark tried to get patients to switch to the Caremark pharmacy, which is owned by CVS, because they were cheaper.

I don't like the idea of insurers stiffing anyone, but I don't like the idea of pharmaceutical companies gouging insurance companies either. That's what makes our premiums go up. I wonder if FHM pulled a Skreli and hiked prices for this life saving drug, and perhaps paid kick backs to pharmacists who filled the prescriptions.