Co-Pays Skyrocketing For Expensive Meds

Health insurance companies are adopting a new pricing model which forces people taking expensive medications to pay up to 33% of the cost, rather than the typically low co-pay.

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.

The linked NY Times article doesn't specifically mention HIV medications, although many pozzers take some of the drugs listed, such as Procrit for HIV-related anemia, and human growth hormone for muscle wasting. Those drugs aside, the annual cost of an HIV drug cocktail can easily exceed $25,000. Obviously, if HIV drugs are included in the new pricing model, we will have a disaster on our hands. I'm hoping that the many JMG readers that work for ASOs can provide more information.