Co-Payments Go Way Up for Drugs With High Prices

I do not know what will solve it, but maybe the ideas of a redistributional managerial state or price controls might seem attractive.

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.

I remember a scene in* Sicko *where a patient was denied the experimental drug Avastin (bevacizumab) for renal cell carcinoma. It was the most lachrymose scene in the entire documentary and an effective piece of propaganda. However, the drugs here are not experimental so they do not have questionable utility. Well, I guess rationing on the ability to pay will be the rationing in the future American system.

Well, I guess having chronic myelogenous leukemia and not having anyone pay for dasatinib (Sprycel) must be inconvienent.

Actually co-pays are a new thing and insurance on prescriptions is even newer.

Years ago when I was a child there was very little medical insurance. Most people just paid out right for all medical care, hospital, doctor visits, and prescriptions (Dentist and Ophthalmologist).

Then I got married while in College and we purchased personal health insurance. We never actually used it because we were a healthy couple and hadn’t gotten pregnant while on it so I don’t remember what the coverage was for that.

We moved, my husband got a job that had health insurance so, company paid a portion of the insurance and we paid a portion of it. All expenses were covered except prescriptions at a 20/80 – we paid 20%, insurance paid 80%. We paid in full for prescriptions and visits to the Dentist and Ophthalmologist.

Second child came along we still have insurance through the company only now we have a 20/80 for prescriptions and not just all other health care.

Third child is born and we now have an HMO. Company still pays the larger portion of health care insurance, we now have Dental and Eye. We have a co-pay for health care – visits to the Dr. or hospital. We are still paying a percentage for medicines – prescriptions. Our Dental is 100% covered for the 2x’s a year visit for cleaning, 80% for all other dental care. The HMO requires an approval to see a specialist!

Years later, we have a co-pay for prescriptions with the prescription insurance company telling us they will not cover certain medicines (think allergy) because one of them went over the counter so you don’t need any of the others! Other medicines require a “review” of why you need to take them. There are different co-pays for different types of medicines. We still have a co-pay for seeing the Dr. but other services (hospital, out-patient, PT/OT) we are back to the 80/20 formula; insurance pays 80%, we pay 20%, We don’t need a referral from the insurance company to see a specialist.

So, we are coming full circle as far as how we pay for our medical care.

Maybe people will resist this and hope for the managerial state.

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