Robert Goldberg
Prescription drugs are 10 percent of our total health care spend. And cancer drugs, despite the hoopla, the coverage, the furor are...less than five percent of that 10 percent. Other biologics are an even small percentage.
So leave it to the HMOs, the ones that want to focus on that teeniest, tiniest part of the health care dollar when it comes to comparative effectiveness, the one part that demonstrably displaces and slows the use of more expensive medical services, to impose a 50 percent co-pay on the average (or as Obama would say, the "ordinary") American for these most expensive meds.
Here's Gina Kolata writing about in the NY Times...
"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, 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."
How about a Tier 20 where you beg the HMO to give you the drug in exchange for your first born?
Here's a story growing more typical by the day:
In January, shortly after Ms. Steinwand renewed her insurance policy with Kaiser Permanente, she went to refill her prescription for Copaxone. She had been insured with Kaiser for 17 years through her husband, a federal employee, and had had no complaints about the coverage.
She had been taking Copaxone since multiple sclerosis was diagnosed in 2000, buying a 30 days’ supply at a time. And even though the drug costs $1,900 a month, Kaiser required only a $20 co-payment.
Not this time. When Ms. Steinwand went to pick up her prescription at a pharmacy near her home in Silver Spring, Md., the pharmacist handed her a bill for $325.
There must be a mistake, Ms. Steinwand said. So the pharmacist checked with her supervisor. The new price was correct. Kaiser’s policy had changed. Now Kaiser was charging 25 percent of the cost of the drug up to a maximum of $325 per prescription. Her annual cost would be $3,900 and unless her insurance changed or the drug dropped in price, it would go on for the rest of her life.
“I charged it, then got into my car and burst into tears,” Ms. Steinwand said.
After all the studies demonstrating that increased co-pays are associated with a rise in sickness, hospitalization, etc...what on earth are HMO's thinking?
_http://www.nytimes.com/2008/04/14/us/14drug.html?hp=&adxnnl=1&adxnnlx=1208192535-86G/GZlEluwU6N3fpEUaig
Prescription drugs are 10 percent of our total health care spend. And cancer drugs, despite the hoopla, the coverage, the furor are...less than five percent of that 10 percent. Other biologics are an even small percentage.
So leave it to the HMOs, the ones that want to focus on that teeniest, tiniest part of the health care dollar when it comes to comparative effectiveness, the one part that demonstrably displaces and slows the use of more expensive medical services, to impose a 50 percent co-pay on the average (or as Obama would say, the "ordinary") American for these most expensive meds.
Here's Gina Kolata writing about in the NY Times...
"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, 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."
How about a Tier 20 where you beg the HMO to give you the drug in exchange for your first born?
Here's a story growing more typical by the day:
In January, shortly after Ms. Steinwand renewed her insurance policy with Kaiser Permanente, she went to refill her prescription for Copaxone. She had been insured with Kaiser for 17 years through her husband, a federal employee, and had had no complaints about the coverage.
She had been taking Copaxone since multiple sclerosis was diagnosed in 2000, buying a 30 days’ supply at a time. And even though the drug costs $1,900 a month, Kaiser required only a $20 co-payment.
Not this time. When Ms. Steinwand went to pick up her prescription at a pharmacy near her home in Silver Spring, Md., the pharmacist handed her a bill for $325.
There must be a mistake, Ms. Steinwand said. So the pharmacist checked with her supervisor. The new price was correct. Kaiser’s policy had changed. Now Kaiser was charging 25 percent of the cost of the drug up to a maximum of $325 per prescription. Her annual cost would be $3,900 and unless her insurance changed or the drug dropped in price, it would go on for the rest of her life.
“I charged it, then got into my car and burst into tears,” Ms. Steinwand said.
After all the studies demonstrating that increased co-pays are associated with a rise in sickness, hospitalization, etc...what on earth are HMO's thinking?
_http://www.nytimes.com/2008/04/14/us/14drug.html?hp=&adxnnl=1&adxnnlx=1208192535-86G/GZlEluwU6N3fpEUaig
