If you have coverage from any of the big insurance companies, the chances are that the formulary is minuscule, compared to the ACTUAL formulary of drugs that are FDA approved for this or that.
Of course, there's a reason for that: denying coverage, or lowering the percentage of the cost paid for the vast majority of meds assures the bottom line for the various insurers.
Husband was getting Synvisc, on a 6 month basis, for the arthritis in his knees. He's also a runner, which means that that's pretty much the only medical care he gets.
About 2 years ago, after covering it for him for over 2 years, BCBS decided that it was "experimental" for arthritic knees, and started denying coverage.
Last year, in preparation for a complaint to the Commissioner of Commerce, who governs insurance companies, I did some research. It was FD approved, specifically for knees, back in 2004.
As we prepared our complaint, BCBS changed their ruling on Synvisc, and made the complaint moot.
About 3 weeks later, there was a note in the business section of the paper: BCBS had been fined by the C of C for improperly denying coverage for many medications.
That, unfortunately, is the flip side of the disgusting ads for meds for everything from depression to restless legs. Even if a med is needed, such as Synvisc for arthritis, or any number of chemotherapeutic drugs for cancers, if you can't get coverage for it, they may as well not exist, because the vast majority of Americans cannot afford to pay for them.
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