Co-Payments Soar for Drugs With High Prices

NY Times ^ | April 14, 2008 | GINA KOLATA

[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...

[markman46]

OK I did a little looking around today and found these cost's:

Procrit: 2k units to 40k units 152.53 to 2602.70 for each injection

Neupogen: 300mg to 480 mg 215.25 to 4409.02 each

Betaseron: kit 2064.48

Remicade: 100mg 697.13

and before you ask where I got this from.. The Redbook, all claims shops have one..

[therut]

Oh I wish patients were more like you. Of the thousands I see each year MAYBE 3 bring in their drug formulary for me. I have NO IDEA what medicine would be best and they sit there and look at me like I should know EVERY patients drug plan. Sorry it does not work that way.

[cherry]

private business and industry employees have always subsidized the public civil servant workers for their drugs and their medical care...

its not very reassuring when I pay exorbitant premiums for my spouse and one child to know that my premiums and deductables are making life so much easier for the public service workers...

maybe now the true cost of drugs will hit EVERYBODY....not just we working stiffs out there..

[cherry]

I read recently...maybe here on FR....that Remicade if given iv can almost completely reverse the effects of Alzheimers...I THINK....trouble is, you would have to take it weekly and its extremely costly....

[markman46]

I believe the Rhumatology’s do give it IV, Yes it is very costly, you would be very surprise just how much $$$ gets paid out. especialy on CHEMO drugs

[SunkenCiv]

29% Favor National Health Insurance Overseen by Federal Government
Rasmussen Reports | April 9, 2008 | Rasmussen
Posted on 04/12/2008 4:21:27 PM PDT by JavaJumpy
http://www.freerepublic.com/focus/f-chat/2000691/posts

[Mr. K]

you just made my point.

The fact that no one knows the costs because of $10 ‘co-pays’ and ‘employer paid’ health insurance is exaclty why costs have risen.

I never said you personally don’t know.