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Blood pressure medication

TA | April 9, 2009

Q: I receive samples from my doctor for my very high blood pressure. She would like for me to get some type of insurance to get a better type of and more expensive medication.

A: Sorry we can not offer the response that you want but this case is a good example of the reason that commercial individual medical insurance policies exclude coverage for the cost of treating pre-existing medical conditions, especially prescription drugs.

Your blood pressure issue is a pre-existing condition with a reasonably predicable cost of treatment in the future. In order for the insurance to operate successfully, the premium cost would have to be raised by more than the cost of the medication in order to cover the insurer's expenses and operating margins. This means that it would be a poor financial deal for you to buy insurance specifically for this coverage. There are, of course, publicly subsidized health insurance plans like Medicaid that are based on financial need that offer prescription coverage for pre-existing conditions. You should investigate these possibilities with your local Medicaid services office, usually a County office. The drawback is that these policies may contain provisions that direct a physician to prescribe less expensive medications. A physician may not prescribe a medication for a Medicaid patient that is not covered by the Medicaid plan.

While it sounds like your medical situation is different than most, the majority of BP patients are usually able to control their blood pressure with inexpensive medications. Generic medications like amlodipine cost only about $15 per month.

Note that the blood pressure will not exclude you from enrolling in a preferred risk health plan, but rather that the medication simply will not be covered.


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