Posted on 04/14/2008 12:32:57 PM PDT by neverdem
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, like $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 to 33 percent, which can amount to thousands of dollars a month.
The system means that the burden of expensive health care can now affect insured people, too.
No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients 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 like 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.
The system, often called Tier 4, began in earnest with Medicare drug plans and spread rapidly. It is now incorporated into 86 percent of those plans. Some have even higher co-payments for certain drugs, a Tier 5.
Now Tier 4 is also showing up in insurance that people buy on their own or acquire through employers, said Dan Mendelson...
(Excerpt) Read more at nytimes.com ...
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
The companies are d*mned, no matter what they do about prescription drugs. If they don’t eat the costs and lose money, they cannot stay in business. If they raise prices, they cannot sell the policies they cannot stay in business. If they make the public pay the difference for newer, higher priced drugs, the politicians and socialist write articles to try and put them out of business.
as ‘unfair’ as it seems, it was ALWAYS a stupid policy to have a fixed ‘co-pay’.
That removed the cost competition factor because the drugs wer $10 (to you) no matter hwere you went.
This set off all kinds of anti-market forces where companies created the most profit making drugs since people had no idea what they cost- they only knew their ‘co-pay’
This is as stupid as my younger brother who once told me he didn’t pay any taxes- he got a ‘refund’ (until I pointed out to him that they took thousands but only gave back hundreds in his ‘refund’)
When our doctor prescribes medicine, we check to see if it is on our Blue Cross Blue Shield formulary. If not, we do not fill the prescription, but ask the doctor for a medicine that he can substitute. There is no reason to take Avelox, an antibiotic that is not covered and costs $130 for 10 pills, when Clindamycin is covered and costs us $5 co-pay for a two week supply.
Patients should refuse to pay for these extravagantly over-priced drugs.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
There is no free market in health care...
We may be related. My wife still has trouble understanding why I would prefer to owe taxes at the end of the year, then be due a "refund" from the IRS.
"Show me just what Mohammed brought that was new, and there you will find things only evil and inhuman, such as his command to spread by the sword the faith he preached." - Manuel II Palelologus
Weed has gotten “very expensive” in recent years. I wonder if it will be included in the new pricing system.
The bottom line is, if my HMO is willing to insure me for it, I’m more than willing to make a “co-pay”.
NOTE: Please see my “tag” below before replying with any self-righteous, humorless, boring anti-drug lectures.
Not really, it is no different than life insurance. They figure how many people are willing to pay for the extra coverage for perscriptions, figure the average payout with “$X” copay and charge that amount for it plus profit. You can have insurance without prescription coverage, you pay more for it so it’s just a numbers thing.
Sounds like they did their math wrong and didn’t anticipate the big jump in prices and doctors prescribing all these new allergy and mood enhancement scripts everyone seems to be on now.
Those over-priced, side-effect riddled, drugs are now being made cheaply in Mexico and China. We’re screwed every which way! Call Hussein Obama and/or Hitlery and they’ll assure you that they have a cure for all of us. Meanwhile, they have their own secret health plan paid for by the US taxpayers.
I’m pretty sure these drugs are this high because of liability the drug companies have to assume for side effects. It always come down to the lawyers.
actually,whats the point of insurance for some of these people. so your trip to the dr is only a $20 copay. then he prescibes a drug you can’t afford. or perhaps you can,but you’ll be homeless. odd how this is happening now,ahead of the election where healthcare will be a point of contention.
the way it reads,they don’t want an ill person getting insurance.
As long as I can afford it, I will pay for Remicade - it is worth a heavy expense, as it makes my arthritis bearable. Costs are out of control, and it’s not because of drug company “excess” profits. The new drugs are a blessing to those of us arthritics who remember when there was nothing but injectible or oral gold and methotrexate, and I would like to see less price and patent regulation.
People like your younger brother are the very reason why our government uses “with-holding” from payroll checks as a means of taxing income. The naive and/or ignorant don’t notice how much they have paid, especially if they get a “refund” at the end of the year.
If there was NO with-holding, and the IRS simply sent out bills every year for income tax “owed”, I am convinced there would be an IMMEDIATE tax revolution in this country.
One of the drugs I take is on that list. It’s Betaseron, an injectible, I take it for MS. What I’ve always wondered is why a drug that has been on the market for 15 years has no generic. I guess it’s because such a limited population uses it, so there’s no money to be made in making a generic.
As of now, my insurance company still treats it as a non-formulary, it’s copay is higher than for other drugs, but it is a fixed copay. If we have to pay a percentage of it (the cost for a month’s worth , 15 injections, is around $1800)...we’ll have to decide what to do. The efficacy is only 33% at reducing relapses, and you have no way of knowing if it’s really working or not...it’s just a crapshoot. But since all the MS meds are about the same, you do what you can do to try to slow down the MonSter.
I pay a $40 co-pay for Xalatan (eye drops for glaucoma). It would be $80 without insurance. It works out to about $1 a drop.
Its worth every penny. Cut my occular pressure in half (from 30 to 15), with no side effects at all.
I recognize that I’m paying for the research that went into this drug.
I may be taking it soon for my auto immune illness. In meantime, I’m on Phase III of clinical trial and it doesn’t seem to be working. My drugs without Remicade would cost me three thousand dollars/mo without insurance.
I say at least they can get the drugs.
In most socialist controlled health care nations, the expensive drugs are simply ‘not available’.
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