The new tiered pricing for drugs

Patients have been shielded from costs far too long, subsequently leading to an entitlement mentality.

Health care is expensive, and people are starting to realize that with the emerging co-payment structure:

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.

Comments

Peter
It is understandably tragic for sick individuals to be forced to pay for extremely expensive medications, especially when the medications will save their lives. However, someone ultimately has to pay for these treatments, whether that is an insurance company of the federal government, and it is no longer economically feasible for insurers to assume almost 100% of the cost in covering high-risk individuals. In the long-run, this will decrease prescription-healthcare costs by decreasing the incentives of moral hazard. I am still wondering if overall healthcare costs decrease as well, or if the increase in untreated individuals will lead to more hospitalizations and higher healthcare costs. From an economic point of view, we have recently seen how preventive medicine actually costs more in the long-run; so, keeping people alive through extremely-expensive drugs might not be the most cost-effective strategy anyways…
Anonymous
The cost of medicine in this country is wasted on the unneeded CT scans and CAM visits. We need tort reform to protect doctors who don’t waste money on expensive tests to rule out the .01% chance of some terrible disease.
Insurance companies should stop paying for acupuncture, chiropractic, naturopathic, homeopathic, etc. These treatments are adjuncts to real medicine. Medicine gets people functional. CAM is extra cost on the system to move people beyond functional. Patients should pay for it themselves, just like botox.
Anonymous
Isn’t this the way it should be? The patient should have some skin in the game regarding how much they cost. It costs something either to the government, other policy holders, and availabe resources in general.
The same should be for worthless MRI’s, CT scans that patients want to consume.
GingerB
I’m sure it’s a shock to go from $20 to $325, but all things considered, the one woman is in an excellent situation.
As a Federal employee she could shop around for another plan, although Kaiser has about the lowest co-pays and deductibles of any that are offered.
She could put the co-pay into her flexible spending plan, which is pre-tax and knock 20-40% off the effective price. Living in Maryland where state taxes are as bad as Federal taxes those pre-tax spending plans are a good way to reduce the bite.
It’s the woman in Florida who doesn’t have any other insurance choices that I ache for. She is in a stuck situation.
LISA EMRICH
“Patients have been shielded from costs far too long, subsequently leading to an entitlement mentality.”
I do not completely agree with this simple statement and might restate it as such: the majority of patients have been shielded from healthcare costs far too long, thus protecting the business models of the pharmaceutical and insurance industries.
As I have yet to fully digest the NYT article, my comments will be somewhat brief. Perhaps I will blog about this in fully detail later this evening.
To Peter who says – “It is understandably tragic for sick individuals to be forced to pay for extremely expensive medications,…” and “In the long-run, this will decrease prescription-healthcare costs by decreasing the incentives of moral hazard.”
To what extent do you truly believe that the concept of moral hazard would come into play in preventing each of the diseases mentioned in the NYT article, which include multiple sclerosis and rheumatoid arthritis?
For instance, science has not yet determined a definitive cause for multiple sclerosis, nor a cure. So how could someone such as myself take more precautions in preventing MS, if I knew that I might be responsible for paying for an expensive biologic drug were I to develop MS?
I appreciated the NYT article but am torn between cheering and booing. As a self-employed musician, I have an individual, private policy and have been subject to much greater cost-sharing than is described here. My policy has had a 4-tier structure for many years, however it is irrelevant in paying for my MS medications since it has an annual cap of $1500, which coincidentally doesn’t even cover the cost of non-biologic medications I take.
I am somewhat pleased that more people will begin to feel the squeeze in facing the costs of their specialty medications, especially if they are ‘secure’ in a FEHB plan. I am also greatly disturbed because these same people will now be competing for resources with folks such as myself when searching for assistance.
Interestingly, the brief NYT article did not address the issue of WHY these drugs cost so much and that the costs continue to rise. Nor did the article discuss the proposed legislation which will actually provide protections to biotech companies who produce these drugs while hiding under the guise of making generic biologics a possibility one day. This is an issue which I’ve blogged about previously.
In discussing healthcare policy and reform, one thing I’ve said all along is that the issue of eliminating the numbers of uninsured in this country is much less important than examining the quality of the insurance being offered. Self-employed persons such as myself who do not have access to employer-sponsored insurance policies, or spousal policies, or government ‘entitlement’ policies, are the ones who I believe truly understand the problems which all those lucky folks have been shielded from for so long.
In 2006, I ended the year with an AGI of $19,400 and pharmaceutical expenses in excess of $16,000 after receiving some assistance in paying for and receiving $30,000 worth of medication. Subsequently, I had no taxable income. However, I still paid about $5500 in taxes.
It is vitally important than individuals with disabling diseases such as multiple sclerosis and rheumatoid arthritis have access (physical and financial) to these medications designed to delay or prevent future disability. These individuals WANT and NEED to contribute economically and socially to social as a whole and to their families. Unless of course we expect their disease to progress to the point where they need to be placed in a nursing facility because they are no longer able to stay independent sooner in life, and then be expected to pay for that cost out-of-pocket as well.
Anonymous
Another story about high priced drugs. I agree we need to have skin in the game to help lower health care costs, but in this case we should also be asking: Why do some drugs cost as much as an automobile or more? Are we to believe medicines have to be priced so high for a pharmaceutical company to make a decent profit? Perhaps having the patient “over a barrel” guarantees outrageous profits, as outlined in these two discussions.
http://blog.healthtalk.com/zimney/
the-high-price-of-some-cancer-drugs/
http://www.aegis.org/news/wsj/2004/WJ041105.html
So many bloggers offer so many possible solutions for our health care system problems as our pandering politicians offer half baked solutions to win more votes and ensure continued campaign contributions from special interest groups (Pharma, Health Insurers, Trial Lawyers, etc.)
Perhaps the real solution is to find a way to get our congressmen to act in a way to achieve a greater good for our society, rather than maximizing personal gain from their political positions.
Anonymous
“Patients have been shielded from costs far too long, subsequently leading to an entitlement mentality.”
Insurance companies are playing games when they move the chips on the board. Kevin’s comment is obtuse; when an insurance company changes the effective policies of a contract, they are protecting billion dollar funds rather than their insured participants. You can claim protectionism and entitlement for those that don’t pay for insurance (either direct or through their employer), but can you really make that remark to someone who has paid for the insurance for the purpose of the protection in the event of the unforseen? – and that is only some of the time that argument would even be valid. Remember the article was less about behavior related disease than those that may not have well identified causal modes. If you think that is not the case – go through the process with a doctor the next time you are diagnosed with cancer, MS or another disease that may have multiple potential etiologies. If you think these are bleeding hearts reacting to this article you have missed the significance of living a purpose-driven life.

The new tiered pricing for drugs

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