Originally published May 15 2008
Insurance Co-Payments Rise for High Priced Prescription Drugs
by Jo Hartley
(NaturalNews) Health insurance companies are currently revising their pricing systems for very expensive drugs and they are now requiring patients to pay hundreds and sometimes thousands of dollars for prescriptions for drugs that may save their lives or slow the progress of serious diseases.
With the new pricing system, insurers have now abandoned the traditional arrangement in which patients pay a fixed amount for a prescription regardless of what the drug's actual cost. Instead, now they are charging patients a percentage of the cost of certain high-priced drugs. This percentage is usually 20 to 33 percent and obviously this can amount to thousands of dollars a month for some patients.
This new pricing system means that the burden of expensive health care will now affect insured people as well as the uninsured.
It is not known how many patients are affected, but hundreds of drugs are now being priced this new way. These drugs are used to treat diseases that are fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some kinds of cancer. Unfortunately, there are no generic equivalents for these drugs, so patients are being forced to pay these prices or go without.
Insurers tell us that this new system will keep everyone's premiums down at a time when some of the newest treatments for conditions like cancer, rheumatoid arthritis, and multiple sclerosis can cost $100,000 and more per year.
The result, however, is that patients may have to spend more for some drugs than they pay for their mortgages. In some cases the drug expenses may be more than their monthly income.
The system is often called Tier 4. It began with Medicare drug plans and has spread quickly. It is now incorporated into 86 percent of those plans. Some have an even higher co-payment for certain drugs and this has been labeled Tier 5. Tier 4 is also now showing up in private insurance plans and employee health. Five years ago, Tier 4 was virtually nonexistent in private plans. Currently 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. The logic behind it is that when people who need Tier 4 drugs pay more for them, other subscribers in the plan will pay less for their coverage.
Private insurers can legally change their coverage to one in which some drugs are Tier 4 with no advance notice. Medicare drug plans have to notify patients but if a patient isn't careful about reading mailings, these notifications can easily be missed. Some patients said they did not know whether their plan had always had a Tier 4 plan or if it was newly added.
Obviously, this new system is placing the burden of huge prescription drug expenses with seriously ill people who thought they had insurance coverage that would help them offset these expenses. Traditionally, the idea of insurance was to help spread the costs of paying for the sick. Now it seems more like insurance is in place to benefit everyone but the patients who need help.
About the authorJo Hartley
Wife, Mother of 8, and Grandmother of 2
Jo is a 41 year old home educator who has always gravitated toward a natural approach to life. She enjoys learning as much as possible about just about anything!
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