Tuesday, April 15, 2008

increasing prescription copayments

From our local newspaper, this story about increasing prescription copayments:

Insurers jack up drug co-pays
Gina Kolata, The New York Times

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.

With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, such as $10, $20 or $30 for a prescription, no matter what the drug's actual cost.

Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 percent to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care is no longer a problem only for people who have no insurance. Instead, the new pricing system can mean that even insured people may not be able to afford the treatments they require.

No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that are not uncommon, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers.

There are no cheaper equivalents for these drugs, so patients say they are forced to pay the price or do without. Insurers say the new system keeps everyone's premiums down at a time when some of the most innovative and promising new treatments for conditions such as cancer and rheumatoid arthritis and multiple sclerosis can cost $100,000 and more a year.

But the result is that patients may have to spend more for a drug than they pay for their mortgages, more, in some cases, than their monthly incomes.

So now instead of going to the pharmacy for a refill to treat your aunt's lung cancer and paying a flat rate of $30 for a month's worth of pills, poor Aunt Sally may now have to cough up a thousand bucks or more. Well, guess what. Aunt Sally doesn't happen to have twelve grand a year lying around to spend on meds, so she's gonna do the next best thing - hit upon her family for assistance.

Imagine a scenario like this one:

Sister: "Hey, bro, how's the new job going? Wanna contribute to the costs of Dad's MS medication?"
Brother: "Sure, Sis, I can kick in a few bucks. How much is it?"
Sister: "Three thousand dollars a month."

Or how 'bout this one:

Mom, to son: "But you have to go to school, honey. Don't you want to grow up to be rich so you can help pay for Grandma's hemophilia prescriptions? We all have to do our part."

OK, one more, then I'm done:

Insurance Company: "Good news, Mr Jones. We've tapped your home equity, your pension and IRAs, and all your life's savings to pay for your wife's rheumatoid arthritis meds. You now qualify for free prescriptions because you're below the poverty level."

We've come around full circle regarding the results of many individuals' acquiring certain illnesses: You get sick, and then soon after, you die. Only now it's not for want of treatment, but for the inability to pay the portion of what your "insurance" will now no longer cover.

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