There are always changes going on with insurance and medication insurance coverage, and one of the most curious phenomenon is ‘uncovered’ medications. Medicines that insurance used to pay for, but they no longer do. This includes a variety of medications: sleeping pills, muscle relaxers, anxiety medications, and hormones….to list just a few.
The reason they are not covering these medications is because they claim that there is no scientific proof that these medications work or that they are scientifically valid, despite decades of use by physicians and patients and a general consensus that such medications are, in fact, valid to use. How did the insurance companies get away with this? Read below.
It started with a valid premise; that insurance companies do not need to cover expensive cancer treatments that are experimental and unproven. About 20 years ago, there were a series of treatments for advanced breast cancer that were under study, but which were as yet unproven to be appropriate treatment. These included special chemotherapy regimens as well as bone marrow transplant therapy. These treatments were expensive and under study as valid treatments, but patients who were desperate for something to work for their advanced cancer were given these treatments before the scientific studies validated their use. These patients fought for coverage from their insurance carriers, due to the expensive nature of these treatments, but the insurers were ‘bullied’ into covering their care, only to find out later, from valid scientific studies, that these treatments were not effective in treating these advanced conditions. As a result, the insurers asked for, and got and exemption to preclude coverage scientifically unproven therapies. This was sensible, and was deemed appropriate, but now it has been extended to virtually all therapies that do not have valid scientific proof. These treatments are not under study nor will they ever be; evaluation was never done and it won’t be done in the future because there is nobody to fund them, no interest, or the costs are too high. This is allowing the insurance companies to hide behind the ‘cloak of science’ to avoid paying various medical costs.
So…..muscle relaxers, sleeping pills, hormone therapies will never be covered. Fortunately, virtually all of these medications are inexpensive, so expect to pay cash for medications in the future that treat these conditions.