Nexium, Prilosec, GERD: HMOs Don't Pay

I had a terrible case of Gastric Acid Reflux Disease (GERD). This is caused when acid from the stomach flows backward up the esophagus and burns your sensitive upper digestive tract from your mouth to your diaphragm. Often the acid reaches your teeth and starts to eat them away. In addition, since this happens more often when you are in lying flat trying to go to sleep, GERD interferes with a restful night's sleep.

Here is the good news. GERD can easily be controlled by a type of medicine called acid pump blockers. These medicines stop the acid from being pumped into your stomach to a degree where not only your heartburn and GERD symptoms disappear but also previous damage to your esophagus is given a chance to heal. Here is even better news. Prescription strength Nexium by Astra Zenica Corporation is a tiny single pill that only has to be taken once a day.

My problems disappeared thanks to Nexium. For the next two years I had no GERD or even heartburn related problems at all. That was until my HMO, CIGNA Health Care, took Nexium off its list of approved pharmaceuticals it would pay for. I was forced to use Prilosec, which was the predecessor to Nexium. For a while this worked but not quit as well as Nexium. I had to avoid some foods before bed. Othewise it was worth it. Apparently everyone else on my CIGNA HMO switched also.

CIGNA then decided that Prilosec, was too expensive for their pharmaceutical plan as well. I received a letter that Prilosec would no longer be covered. They included a free coupon for a free 14 pill pack of Prilosec OTC and suggested I use that from now on. Very generous, Prilosec OTC is only half the strength of the prescription dose. I found out through painful experience that it took two Priolosec OTC pills to stop GERD. It cost about $30 for a 48 pill pack of Prilosec OTC. This is a 24 day supply.

What my CIGNA HMO had in effect done was to make me pay in full for my own medication while they saved whatever money they had previously paid. My Prilosec prescription had cost me a $20 co-payment for a 90 day supply. Now I was paying over $100 for an over the counter version of the same drug . To further cost me more, the over the counter version is not tax deductible while the prescription is.

In effect my HMO which I pay over $500 a month for and my employer pays even more, decided to earn greater profits by not paying for the best medication for the medical condition, and then decided not to pay at all. See my article entitled: HMO Don't Pay for additional ways HMOs increase their profits by not paying for the best healthcare.

Currently I am paying for a second rate medication, which costs me five times as much as the prescription brand I was previously taking. This medication switch seems to be getting more and more prevalent among HMOs. They have tried to take me off other medications. Apparently they received so much flack from this that they said they had made a clerical mistake and rescinded the changes.

This is what I am wondering. If I have Health Insurance and pay dearly for it, what happens to people who can't afford Health Insurance at all. I certainly see why bus loads of U.S. Citizens cross the Canadian border each day to acquire their prescriptions. There is just something wrong with a Health Insurance Company that that is more interested in making huge profits than providing the best heath care for its participants.