Tahlequah Daily Press

Local News

August 20, 2012

Healthcare law expands drug coverage

TAHLEQUAH — When the Patient Protection and Affordable Care Act passed Congress in 2010, it expanded coverage for 47 million uninsured Americans, and that includes expanded coverage for prescription medications.

The U.S. Department of Health and Human Services projects prescription drug spending to increase from $234.1 billion in 2008 to $457.8 billion by 2019 – almost doubling over the 11-year period, due in part to enhanced coverage under PPACA.

According to a 2010 report by the Kaiser Family Foundation, PPACA cites prescription drug coverage as one of the “essential health benefits” mandated for health plans in both state health exchanges and in the benchmark benefit package or benchmark equivalent under Medicaid for newly eligible adults.

Those whose prescription medications are covered by employer-provided healthcare plans under flexible spending accounts, health savings accounts or reimbursement arrangements will experience a few changes when claiming over-the-counter medications on their taxes.

PPACA provides that expenses for OTC drugs or medicines other than insulin, incurred on or after Jan 1, 2011, will only be eligible for reimbursement under a Health Flexible Spending Account, Health Reimbursement Arrangement or Health Savings Account for IRS purposes if they are “prescribed.” OTC medical supplies and equipment – such as contact lens solutions, bandages, crutches, durable medical equipment, or diagnostic devices like blood sugar test kits – may still be purchased under the current process.

Patti Gulager, a local registered nurse who has read the PPACA law in its entirety, said some insurance plans have already begun requiring prescriptions.

“Some plans have been moving to the prescriptions for OTC drugs,” said Gulager. “Our personal health care plan today does, in order [for us to receive the tax benefit]. Medications requiring prescriptions include Prevacid, Zantac, etc.”

Jesse C. Vivian, registered pharmacist and professor of the Department of Pharmacy Practice, College of Pharmacy and Health Services at Wayne State University, in Detroit, believes the overall effects of PPACA should be good for pharmacy providers, in terms of the number of people eligible for prescription benefits.

In a report in uspharmacist.com, Vivian said some group health plans will no longer be able to impose lifetime or annual limits on healthcare expenditures, including prescription drug reimbursements.

“By 2014, no group health plans or group health insurers will be allowed to enforce any annual spending limits on covered employees and dependents, and will be only allowed to impose lifetime benefit limits on nonessential health care spending,” wrote Vivian. “Likewise, insurers cannot rescind specified covered benefits, except in cases of fraud or intentional misrepresentation by a benefit applicant, after they are offered. However, this does not mean employers cannot terminate health plan coverage entirely for employees who are eligible for alternate government-sponsored plans.”

Sen. Tom Coburn, R-Okla., is also a physician who is opposed to PPACA. He believes the law encourages employers to drop coverage for employees, thereby increasing costs to taxpayers.

“[But] there is still time to avoid the loss of high-quality private coverage and subsequent costs to taxpayers,” said Coburn. “Businesses are most likely to start dropping coverage in 2014, the year the biggest insurance changes and employer penalties begin. [I] support repealing the law before 2014, and replacing it with reforms that do not discourage employers from offering coverage and lower costs.”

Gulager believes PPACA will streamline pharmacy services, especially those covered by Medicare.

“Right now, the large number of plans out there are confusion as to [benefit caps],” said Gulager. “The insured also have limits on how much they can obtain in a benefit year. There should be less seen of this in the new design. Right now, lengthy letters of [medical] necessity, as well as charity from drug companies, are needed to provide the needed amounts [of prescription medications to pharmacies]. In the discussions I have heard recently, access to [preventive care] and early detection may keep the need for more of the high-end, [expensive] drugs down overall.”

Effective Aug. 1, PPACA expanded coverage for women, providing a number of services cost-free, including contraception. Many have wondered if certain medications, like Viagra, will now be provided at not cost to men, or if other medications will be excluded. Gulager said the cost of Viagra prohibits the possibility of its being made free to all men.

“I am not aware of any medications that [won’t be covered] under the act,” said Gulager. “When you look at contraceptives being [made available] at no cost, it is very different from Viagra. [Erectile dysfunction] drugs have very tight patents and have been on the market a very short time [compared to contraceptives]. If you look at drugs, in general, you know that the longer they are available and the amount of [competing companies making them] drives the cost down. Since the use of Viagra is considered non-life-sustaining, I wouldn’t look for any changes in the distribution anytime soon.”

Julie Ward, vice president of finance for Tahlequah City Hospital, said while there may be some limitations to specific procedures, she anticipates coverage for all citizens being similar to those provided under Medicare.

“We would anticipate those who are covered will have benefits similar to Medicare, with the same pre- and post-screening processes to ensure adequate physician and hospital documentation, the physician identifying the required codes, and correctly determining the required status of the patient,” Ward said. “If the physician is not completely compliant with these regulations, the hospital’s reimbursement is negatively impacted.”

TCH offers counseling on covered insurance benefits, but Ward said patients have a responsibility to educate themselves about coverage.

“We have invested significant resources into the patent access process to ensure our patients get all of their needs met,” said Ward. “We also believe insurance companies have a duty and a responsibility to educate their customers on their benefits. Our experience is that Medicare communicates fairly well with their customers. Finally, the patient has a responsibility to learn what benefits they are entitled to.”

Gulager believes PPACA provides expanded opportunity for physicians and clinics to expand their practices, as well as improving outcomes for patients overall.

“The access should be easier for getting the medications you need, and especially pleasing to me is the pediatric component,” said Gulager. “So many children are going to get the medications they need in a timely manner. Hopefully, families won’t have to make the choice between buying medication for a child or food for the family.

To see the complete version of this article, subscribe to the Daily Press e-edition by following the link below.

Click here to get the entire Tahlequah Daily Press delivered every day to your home or office.

Click here to get a free trial or to subscribe to the Tahlequah Daily Press electronic edition. It's the ENTIRE newspaper (without the paper) for your computer, iPad or e-reader.

Text Only
Local News
  • SR-WalkaMile1.jpg Walk a Mile 2014

    Men squeezed into feminine footwear Saturday by the hundreds to walk in solidarity with women on the issue of sexual violence – and their clop-clop-clopping echoed down Muskogee Avenue.
    The fourth annual “Walk a Mile In Her Shoes” brought men to Norris Park, accompanied by their enthusiastic female supporters, to walk – and often wobble – in high heels over a mile-long course to raise funds for Help-In-Crisis.
    “It hurts every year,” said John Christie, a Sequoyah High School student participating in his third Walk a Mile. “I get home, sit down, blisters come up and the calves hurt. But it is worth it. It’s for a good cause.”

    April 22, 2014 2 Photos

  • adams-christopher.jpg Michigan man gets 13 years on plea to rape, sodomy of girl

    A 28-year-old Michigan man will spend about 13 years in an Oklahoma state prison after pleading guilty to four counts of first-degree rape and one count of sodomy involving a 13-year-old girl.
    Christopher Dale Adams, of Lake Orion, Mich., received a 13-year prison sentence for each of the five charges, to be followed by seven years suspended. All sentences will run concurrently.

    April 22, 2014 1 Photo

  • logan-amy.jpg Police take down pair on pot distribution charge

    Tahlequah police officers arrested a pair Sunday night for allegedly possessing marijuana with the intent to distribute it.
    Tahlequah Officer Cody Warren said police were asked to investigate when 35-year-old Amy N. Logan, of Tahlequah, allegedly took a family member’s car without permission.
    While Warren was speaking with the owners of the vehicle, Logan arrived along with 26-year-old Theoplilus James Mollie, of Tulsa.

    April 22, 2014 2 Photos

  • land-lisa.jpg Two nailed with meth, pot hidden in bag of chips

    Two people were arrested early Monday morning when Tahlequah police stopped a vehicle near Basin Avenue and found methamphetamine and marijuana hidden in a bag of chips.
    Tahlequah Officer Cory Keele said he noticed a Nissan heading north on Park Hill Road, and the vehicle later stopped in an intersection.

    April 22, 2014 1 Photo

  • gawf-johnny.jpg Nylon case doesn’t fool deputy; drug charges to be filed

    A Tahlequah man is jailed at the Cherokee County Detention Center after being arrested on drug possession charges.
    Deputy Michael Cates stopped Johnny Lee Gawf, 25, near Stick Ross Mountain Road and U.S. Highway 62. Gawf did not have his driver’s license and had a no-bond warrant for failure to pay.
    When Gawf was asked to step out of his vehicle, he allegedly reached into a pocket and pulled out a black nylon case, which he claimed to be a pocket knife. Gawf sat the case in the seat of the vehicle.

    April 22, 2014 1 Photo

  • ts-CN-citizenship.jpg Dual citizenship still OK for tribes

    It’s been almost a year since the United Keetoowah Band of Cherokee Indians in Oklahoma was forced to close its casino, leaving about 150 members without jobs.
    Right before the operations was shuttered, Cherokee Nation Principal Chief Bill John Baker offered a plan to absorb UKB employees, scheduling three employment registration meetings in September 2013.

    April 22, 2014 1 Photo

  • TPS to hold graduation at Doc Wadley, after all

    A letter obtained by the Tahlequah Daily Press states that graduation exercises for the Tahlequah High School Class of 2014 will be held at Doc Wadley Stadium on May 23.
    Tahlequah Public Schools received an invitation from the city and Northeastern State University to hold the graduation ceremony inside the NSU multipurpose event center, and the district was initially agreeable. But the necessity of limiting invitations to 10 or 15 per student because of seating concerns drew heavy criticism from seniors and parents.

    April 22, 2014

  • Woman allegedly went after relative, then cop

    Deputies say a 22-year-old woman assaulted a family member Saturday, then attacked an officer when he tried to arrest her.
    Deputy Bryan Qualls was sent to investigate the domestic disturbance at Hilltop Circle. Donna Wilder, the alleged victim, told Qualls that the suspect, Kaylynn Sharp, was hiding in the garage, and had struck her in the face several times.

    April 22, 2014

  • jn-city-pool.jpg City of Tahlequah progressing on bond projects

    Just more than a year after the city began collecting a sales tax funds for use on capital improvements, crews continue to work toward finishing several of the projects.
    “We’re going to deliver everything we said we would,” Tahlequah Mayor Jason Nichols said Friday.
    The $21-million-plus bond issue approved in 2013 includes about $10 million worth of street projects. South Muskogee Avenue will eventually be widened into a five-lane stretch; East Fourth Street’s widening project is underway; and West Fourth will become, at least in part, a three-lane road.
    Projects will also focus on parts of North Grand, East Allen, Bluff, Crafton, and North Cedar.

    April 21, 2014 1 Photo

  • duvall-dustin.jpg Four men charged with burglary

    Four local men are facing burglary and stolen-property charges in Cherokee County District Court.
    Prosecutors have charged the four men with second-degree burglary and knowingly concealing stolen property.

    April 21, 2014 3 Photos


How confident are you that the immunizations for infants and children are reasonably safe?

Not at all confident.
Somewhat confident.
Relatively confident.
Extremely confident.
     View Results
Tahlequah Daily Press Twitter
Follow us on twitter
AP Video
Raw: Deadly Bombing in Egypt Raw: What's Inside a Commercial Jet Wheel Well Raw: Obama Arrives in Japan for State Visit Raw: Anti-Obama Activists Fight Manila Police Motels Near Disney Fighting Homeless Problem Michigan Man Sees Thanks to 'bionic Eye' Obama to Oso: We'll Be Here As Long As It Takes Bon Jovi Helps Open Low-income Housing in Philly Pipeline Opponents Protest on National Mall Hagel Gets Preview of New High-tech Projects S.C. Man Apologizes for Naked Walk in Wal-Mart New Country Music Hall of Fame Inductees Named 'Piles' of Bodies in South Sudan Slaughter SCOTUS Hears Tv-over-Internet Case Chief Mate: Crew Told to Escape After Passengers Iowa College Finds Beauty in Bulldogs