DALLAS -- As a self-employed DJ, Tim Conway buys his own health insurance.
He was pleased with the plan he found in the health insurance marketplace, until he needed a prescription for specially made medicine.
"I don't have coverage, that's what they told me," says Conway. "I don't have any compounding coverage."
Conway has a gold plan, one of the highest tiers of insurance available.
"There's been some research," says Devon Herrick, a health economist with the conservative National Center for Policy Analysis. "That has shown since last year, that in fact the number of plans that place restrictions on prescription drugs has increased slightly."
Herrick says many health insurance companies are cutting back because enrollees are sicker than anticipated.
"That can drive up the costs of the plan," he explains. "Meaning premiums will rise next year. So a way plans tend to deal with that is they might increase the cost sharing for certain drugs or certain services, which allows the plan to provide a cheaper premium."
Within 259 pages of fine print, Tim Conway's plan states it "does not provide coverage for compounded medications."
In a statement to News 8, Margaret Jarvis, senior manager of media and community relations at Blue Cross and Blue Shield of Texas says, "BCBSTX covers certain compound drugs subject to a prior authorization process."
Tim Conway says he couldn't have predicted he would need such a drug. And the out of pocket cost for it is far from affordable.
"The pharmacist said it was about a thousand something," Conway says.
He's decided to switch plans. Experts recommend carefully searching plans in advance for medications patients know they take.
If a medicine needed in the future is not on the list, many companies will cover them on a case-by-case basis, if patients appeal.
