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Prohibitive Prescriptions

You can tell a lot about a person by what in their medicine cabinet. A quick peek during a trip to the bathroom and the nosy neighbor could find out whose taking anti-depressants or birth control pills. Maybe someone is being treated for heart disease or bipolar disorder. Or perhaps someone is taking antibiotics for any number of conditions, from a sinus infection to an STD. Certain medicines, if you know what to look for, are a clear sign that someone is undergoing treatment for cancer or HIV.

Of course, most of keep to ourselves what medications we’re taking. That’s why they’re behind the medicine cabinet door, and not lined up on the kitchen counter. Most of us don’t go snooping in other people’s medicine cabinets. (Do we?) And if we did, the worst we could do with the information is use it to spread gossip.

That is, unless we’re in the business of looking into other people’s medicine cabinets, or using the information obtained by those who are poking around in the nation’s medicine cabinets..

You did know that there’s a thriving business in buying and selling your prescription information, right? When you pick up your prescriptions, somebody besides you and your pharmacist knows what’s in that bag.

An untold number of people have been rejected for medical coverage for a reason they never could have guessed: Insurance companies are using huge, commercially available prescription databases to screen out applicants based on their drug purchases.

Privacy and consumer advocates warn that the information can easily be misinterpreted or knowingly misused. At a minimum, the practice is adding another layer of anxiety to a marketplace that many consumers already find baffling. “It’s making it harder to find insurance for people,” says Jay Horowitz, an independent insurance agent in Overland Park, Kan.

Anxiety? You could call it that. For most of us, who have healthcare through our employers, there’s not much to worry about. But for those who have to purchase individual insurance – and in this economy that could be any of us, since health insurance is usually attached to employment. So any of us could be in the same position as the Sheltons.

Walter Shelton, a 57-year-old safety consultant in the oil and gas industry, says he tried to explain that the medications weren’t for serious ailments. The blood-pressure prescription related to a minor problem his wife, Paula, had with swelling of her ankles. The antidepressant was prescribed to help her sleep-a common “off-label” treatment doctors advise for some menopausal women. But drugs for depression and other mental health conditions are often red flags to insurers.

Despite his efforts to reassure Humana, the phone interview with the company representative “just went south,” Walter recounts. He and his wife remain uninsured.

“I want to know what’s in there if there’s a black mark against us,” Walter says. Paula, 51, adds: “We can’t get health insurance because we’re taking medications that were prescribed by our doctors. I don’t think that’s right.”

A spokesman for Humana says the company uses “data regarding pharmacy history as part of our assessment process.” But he adds that the insurer has a policy of not commenting on particular cases, such as the Sheltons’ failed application.

Basically, needing health care – specifically needing particular medications – can disqualify you for health care coverage. For $15, insurance companies like Humana, Blue Cross, Aetna, or United Health Group can get a virtual peek into your medicine cabinet via a “pharmacy profile” provided by companies that gather information initially intended for to help doctors treat emergency room patients, but which has since been put to a more profitable use. After all, $15 to “identify high-risk, reduce costs, lower loss ratios, and increase revenue” is pretty cheap compared to the cost of covering those individuals.

And if it seems like, y’know, providing care isn’t on that list of priorities, remember health insurance companies never really deny care. They merely deny coverage. You can always get care, provided you can pay for it. Of course, in an economy where rising health care costs are cutting into wages, almost none of us can handle the cost of serious illness or injury; or even the cost of getting old, for that matter. Look at the rise in bankruptcy among senior citizens, struggling to pay for their health care expenses. Even those of us who are insured are cutting back on medical care, squeezed between rising prescription costs, premiums, and even gas prices. American medical care might be the most expensive in the country, but most of us already aren’t getting our money’s worth.

And John McCain’s health plan would make surea good many of us get even less — something he probably knows right down to his $520 Ferragamo loafers, given that his own cancer history (with its attendant prescription history) would probably result a denial of coverage if he were almost anyone else besides Sen. John McCain. Somewhere in his 1,100 pages of medical records, some insurance industry employee would find something to “identify high-risk, reduce costs, lower loss ratios, and increase revenue.”

But John McCain would never have to live with the realities of his own radical health plan, which would raise costs by dismantling the employer-based coverage system that insures 60 percent of us, putting us in the same position as the Shelton’s; with a medicine cabinet full of prescriptions we need to keep us healthy, that could also get us denied health care coverage because they’re instrumental in helping the insurance health industry “identify high-risk, reduce costs, lower loss ratios, and increase revenue.”

So, again, what’s in your medicine cabinet? Most likely, a prohibitive prescription or two.

[Photo via Merrick Brown.]

Crossposted from the Republic of T.

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