General Discussion
In reply to the discussion: This message was self-deleted by its author [View all]Ms. Toad
(34,069 posts)Lovenox (subcutaneous heparin) was excluded from coverage for any use other than pre-treatment for surgery. I gave you several links which described what was going on at the time. The vast majority of people who tried to obtain coverage (under any policy) to use it to treat DVT were denied because it was excluded from coverage. At least one of the articles I linked to mentioned this and, as I said, the TV show ER had an episode within a year of my encounter with the standard outcome - the coverage was denied and the patient had to be hospitalized for 5-10 days (standard treatment at the time) when it would have been a whole lot cheaper to pay ~$500 (at the time) for a Lovenox prescription.
My doctors were successful in advocating for me to get it covered, even though it was excluded from coverage.
This was before formularies played a significant role - so it wasn't a matter of getting an exception to the formulary. It was also, under my plan, classified as medical care (rather than prescription).in connection with a single permitted use. One of the articles I linked to mentioned this weird coverage split (prescription v. medical).
As to wanting to repeal the ACA - there are plenty of folks on DU who want to see it abolished. They want single payer, but in the mean time they want the ACA gone. And rants like the one which started this thread aren't helpful.