Tuesday, March 30, 2010

Tuesday Tidbits

The President signed into law today the package of amendments to the Patient Protection and Affordable Care Act (H.R. 4872) that Congress passed on Thursday under its budget reconciliation rules.

A Wall Street Journal article captioned "Flap over Children's Coverage Settled" incongruously discusses the FEHB Program in the context of a dispute over the scope of the new law's restrictions on pre-existing condition exclusions:
Jade Harmer, 13, of Fredericksburg, Va., might be able to benefit from the health bill's immediate provisions. Her mother, Tina Harmer, said the family's insurance, a Blue Cross Blue Shield plan that is part of the Federal Employee Health Benefits Program, wouldn't cover weekly $1,000 drug injections for Jade's multiple sclerosis.
The Blue Cross Blue Shield Association, which administers the Harmers' plan, couldn't comment on the specifics of the case. But Jena Estes, a vice president there, said the drug in question was not approved for use in children.
Ms. Harmer applied to several other insurers but said her daughter was turned down because of her health condition. She was hoping that with the new health-care bill she could find a policy that would cover her daughter's treatment.
"I've been keeping a close eye on health reform because I know it would help with pre-existing conditions, but a few things worry me," said Ms. Harmer. "Is it what they say it is?"
As a parent, I sympathize with this mother, but I don't get her point. The FEHB Program does not permit pre-existing condition exclusions or limitations, and it has a disputed claims process that is controlled by OPM, not the health plans, which is a very fair deal to federal and postal employees and annuitants. Off label use of prescription drugs is not a matter to be taken lightly considering recent federal prosecutions against drug manufacturers that alleged marketed off label uses for certain prescription drugs. The American Cancer Society offers a useful discussion of the topic on its website.

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