This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
Notably absent from the debate about our nation's failing health care system is any discussion regarding the disaster known as Medicare Part D: the prescription drug program for people on Medicare. Created with bipartisan support under the Bush administration, this program allows insurance providers to dictate to physicians and patients the specific drugs they are allowed, as well as the prices involved. In collusion with the pharmaceutical companies the profit margins of both businesses are greatly enhanced at the expense of the patient or judgment of their doctor. In other words, it's a "racket."
My own experience as a retired state employee serves as an example of this lack of choice and the restrictive health care that results. Utah Public Employees Health Plan (PEHP) is mandatory, as is their only contracted prescription drug provider: Express Scripts. Upon retirement if you wish to utilize unused sick hours for future coverage, this is your sole choice. I was told by a PEHP representative that this program provides the "best" coverage. It is anything but that.
Immediately upon entering Medicare Part D, PEHP and Express Scripts mandated prescription changes and my monthly costs went up. Suddenly this year, the provider ceased coverage of a drug they've provided for 22 years without offering any explanation or alternative choice.
My doctor has been denied three appeals on my behalf, none of which considered the issue of medical necessity. As he pointed out, be prepared to open your wallet or forgo treatment and eventually be hospitalized. He wryly added that I should check out how well this insurance provider is currently performing in the stock market. After all, that is the bottom line.
Brett Clifford
Salt Lake City