If this has happened to you or you know someone it has happened to,
vlog it, spread the word, especially in a campaign year.
http://www.nytimes.com/2008/04/14/us/14drug.html?
pagewanted=1_r=1no_interstitial
Only the first page is below
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 of Avalere
Health, a research organization in Washington. It is the fastest-
growing segment in private insurance, Mr. Mendelson said. Five years
ago it was virtually nonexistent in private plans, he said. Now 10
percent of them have Tier 4 drug categories.
Private insurers began offering Tier 4 plans in response to employers
who were looking for ways to keep costs down, said Karen Ignagni,
president of America's Health Insurance Plans, which represents most
of the nation's health insurers. When people who need Tier 4 drugs
pay more for them, other subscribers in the plan pay less for their
coverage.
But the new system sticks seriously ill people with huge bills, said
James Robinson, a health economist at the University of California,
Berkeley. It is very unfortunate social policy, Dr. Robinson
said. The more the sick person pays, the less the healthy person
pays.
Traditionally, the idea of insurance was to spread the costs of
paying for the sick.
This is an erosion of the traditional concept of insurance, Mr.
Mendelson said. Those beneficiaries who bear the burden of illness
are also bearing the burden of cost.
And often, patients say, they had no idea that they would be faced
with such a situation.
It happened to Robin Steinwand, 53, who has multiple sclerosis.
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.
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.
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.
She needed the drug, she said, because it can slow the course of her
disease. And she knew she would just have to pay for it, but it would
not be easy.
It's a tough economic time for everyone, she said. My son will
start college in a year and a half. We are asking ourselves, can we
afford a vacation? Can we continue to save for retirement and
college?
