Co-Payments Go Way Up for Drugs With High Prices

[babylonsister]

Co-Payments Go Way Up for Drugs With High Prices

By GINA KOLATA
Published: April 14, 2008


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.
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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.

more...

http://www.nytimes.com/2008/04/14/us/14drug.html?_r=1&adxnnl=1&oref=slogin&ref=todayspaper&adxnnlx=1208172130-JAb1lAEGmh2sw0zEum/pHg

[MiniMe]

1. I guess paying for those drugs may interfere with their obscene salaries

and bonuses, or the amount of money that would be available for TV advertising. Isn't the point of insurance to spread the cost of things like that across a large pool of people so it doesn't hit anybody too hard?

[warren pease]

17. The point of insurance...

You ask, "Isn't the point of insurance to spread the cost of things like that across a large pool of people so it doesn't hit anybody too hard?"

You'd think so, wouldn't you? After all, that's the theory of big numbers at work. But that's not the case here at all. Anything but. If we wanted to spread the risk over the largest possible pool, we'd have a single-player system that includes all 300 million plus Americans.

Since we don't, you can make certain inferences, starting with the fact that medical insurance has nothing whatsoever to do with health care except in the twisted minds of Chicago School libertarian fanatics and free market pitchmen.

We're not really talking about medical insurance anyway; it's protection money paid to an organized crime syndicate to keep medical providers from stealing your house, cars, bank accounts and anything else that isn't bolted down in case something serious (i.e., expensive and maybe requiring hospitalization) happens to you.

And how do we allow such an unfair, destructive system to interfere in our lives when all other industrialized countries do much better? After all, their systems produce better quality-of-life statistics and superior treatment outcomes at far lower per capita costs. So why do we put up with this bullshit system? Simple. We're idiots.

The US is unique in the world in its child-like belief in corporate good citizenship and the intrinsic benevolence of a medical system based solely on profits. This is not only naive and dumb as dirt, it can't happen under US law and SEC regulations that demand a publicly owned, for-profit corporation base its entire business model on achieving one single objective: maximizing shareholder equity.

So anything that bumps the stock price is good, and anything that lowers it is bad. Paying claims is bad because it sucks money from the bottom line, while denying claims is great because it saves money that contributes to corporate profitability, which ultimately helps raise the price of the stock, keeps the investors happy and keeps the SEC off the CFO's back for another quarter.

In short, it's literally impossible for a US for-profit publicly held medical insurer to live up to its opposing obligations to both its subscribers and shareholders at the same time. And, as noted above, if somebody has to get screwed, by law it's going to be the peasants.

And that's the short version of how the profit motive combines with lack of corporate accountability, an insupportable belief in intrinsic corporate goodness, a culturally ingrained resistance to anything that wingnut demagogues can label as "socialist," and a corollary trust in market solutions to social problems -- despite the fact that the only problems typically addressed are the temporary cash flow problems the solution's pitch men may be experiencing -- to produce the most expensive, least accessible, most elitist and most inefficient medical system in the entire industrialized world. And in quite a few countries that can't make any claims to industrialization, as well.

Here's a recent chart updating the World Health Organization's landmark 2000 comparative study of 190 countries' medical systems. Note that, at 37th, the US ranks behind all EU countries, UK countries and a bunch of others who just do a better job of taking care of their citizens' medical needs.

And that's the bottom line, unfortunately. In the US, any connection between medical insurance and good health care is purely accidental.


wp

[OhioChick]

2. K&R

:kick:

[Breeze54]

3. I think it's a push to get patients to use generic drugs, which are cheaper.

I saw a piece about that subject over the weekend.

[kdmorris]

10. Most of these drugs do not have a generic available yet.

There's no excuse for this.

[librechik]

20. yes, that too would remove the profit from the system--& that is more important than patient health

for these private companies--watch them fight generic versions tooth and nail!

[kdmorris]

24. Oh, they do!!!

They fight the patent expiration like it's their personal enemy (well it's the enemy of their profits). They will find every loophole they can to stop a generic being made because they will get to keep charging ridiculous, exorbitant prices on drugs that people need to keep them alive.

[trof]

4. Yeah, tell me about it.

I have MediCare Rx insurance.
Costs me about $35 a month.
Doc just changed one of my BP meds due to side effect.
The old med had zero co-pay.
The new one?
$75 co-pay for 90 pills.

[babylonsister]

5. Wow. That's the problem with new drugs; there are no generic

equivalents yet. I always wonder if docs are pushing this new stuff because of kickbacks or favors they receive-call me cynical.

[Breeze54]

6. Actually, the "new" drugs are the same as the old generic, in a lot of cases.

That's what that program said the other night. The Big Pharma companies are just changing minute
chemicals and then renaming the old drugs and marketing them as new, in a lot of cases. If I need
a prescription, I always ask for the generic.

[babylonsister]

7. What I'm saying is there are no generic equivalents in some cases.

Those cases apply to the really expensive drugs, naturally.

[Breeze54]

8. That's probably true but the way the * FDA approves "new" drugs?

I wouldn't trust using them anyway. I'd want the old drug instead!

[knitter4democracy]

13. Like all of the asthma inhalers.

They changed them to get rid of CFCs, and because it's a new delivery system, the FDA said they're new drugs. Even albuterol that's been used for ages. So, now they're all new drugs with high costs again. My kids' inhalers cost $220 each for a month's worth before our deductible kicked in. Now we pay $60, but that still adds up fast.

[Breeze54]

16. Yup! My son used to take liquid albuterol...

I don't know if it's still available.

[trof]

9. No, I trust my doctor.

And, based on advice from a good friend who is a retired physician, I asked for the change.

[knitter4democracy]

12. No kickbacks here.

Hubby hates using new drugs because they cost his patients so much. So, he reads up on why it's new, and it's often something tiny and meaningless. He's got his heart failure regimen to about a hundred bucks, and he only uses pricier stuff if the cheap stuff doesn't work or has bad side effects. He hates the drug reps, too, and does what he can to avoid them.

He gets pens from them. And samples to give to his patients who need the drugs and can't afford them. That's it.

[babylonsister]

14. I'm sure there are many ethical docs; I've also read there are many

who aren't. I belong to an HMO; I wouldn't have a clue how to tell from the little contact I have with a doc.

[knitter4democracy]

21. You can ask the office manager.

Most practices have a clear-cut policy when it comes to drug reps. Hubby's old one had a nurse be the referee, and the only way he ever ran into one was by accident or in the hospital. His current one allows them to provide lunch on Tuesdays (his half day, so he leaves to round then) and breakfast on Fridays (so he rounds then and goes in after it's done).

[Liberal In Texas]

27. I asked a nurse in my docs office, she said an drug rep ADMITTED

that they change a molecule here or there to get a new patent, change the name and sell basically the same drug at higher prices.

Also, like pushers, they give you samples to start out with. Once you're "hooked" then you have to buy the stuff at a premium.

It's a racket. It should be illegal.

Please please, can we have European or Canadian type health-care here?

[elizfeelinggreat]

11. k & r

Very important - it's one assault after another and the corporations will keep this up until we remove every politician who allows this stuff. Want to see healthcare reform? This seems to me to be the BEST way to guarantee it. Of course maybe they see this coming and want to rake in the money while they can.

[suffragette]

15. Interesting that this is addressed as keeping premiums down, but

nowhere does the article bring up the obscene profits and salaries in the insurance industry.
That's the real offset and it should be highlighted in any article about increases in prices the insurance company charges.

[warren pease]

18. They just shift the burden, then blather about how they're "keeping health care affordable..."

Seems to me it would be considerably more affordable if these parasites weren't standing in the middle of the gigantic river of medical money and skimming between 25 and 40 percent of the gross.

And what's worse, the only real service they provide is robbing you blind with bloated premiums, copays, deductibles and those little discrepancies between the "negotiated settlement" and what the doc actually billed -- which of course is your responsibility to cover.

Unlike our own single-payer system -- Medicare -- which runs at between 2 and 3 percent overhead, the for-profit thieves squander insane sums of money on paper pushing, shareholder return, marketing, benefits verification, advertising, executive salaries, claims denial and other elements of the managed care bureaucracy – none of which do a single thing to provide actual health care. The shareholders are happy little bastards, though.

In 2005, the last year I've seen comprehensive and audited numbers for, the American health care machine was a $2 TRILLION business, or $6,697 per capita -- by far the most expensive system in the world. Which means -- using the industry's own figures of running at between 25 to 40 percent overhead -- that at least $500 billion, and as much as $800 billion was wasted in 2005 on non-medical items. I would bet all those dollar figures are somewhat higher today.

And what do we get for all this money? "The position of the United States is one of the major surprises of the new rating system," says Christopher Murray, M.D., Ph.D., Director of WHO's Global Programme on Evidence for Health Policy. "Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries.

"The United States rated 24th under this system, or an average of 70.0 years of healthy life for babies born in 1999. The WHO also breaks down life expectancy by sex for each country. Under this system, U.S. female babies could expect 72.6 years of healthy life, versus just 67.5 years for male babies."

You can read the whole news release and link to various depressing reports here.

Ah, yes. It's morning in America, as St. Raygun said. Just hope you survive the night without getting murdered by the American way of medicine.


wp

[librechik]

19. while continuing to retain a healthy profit margin for our investors

that's what's most important in a privatized system, after all...

[suffragette]

23. Parasites is an apt term

They both divert the money into their own pockets and interfere in medical decisions by determining what care will be covered and what will not.

I imagine even more people will be trying to get along on half dosage or without necessary medication because of this.

All the points you make are so important.

One that stood out for me, mostly because I haven't seen it highlighted before while I am familiar with the others, is the connection between Americans spending more time disabled because of the current system. That's an area that needs to be brought up more often.

What I really want to see and will continue to push for is for more people in Congress to sign on with HR 676. That's the bill I want to see land on the new President's desk for signing.

[Corgigal]

22. Another contract with corporate America

that doesn't mean a damn. You sign up for these insurance policies believing the print but end up being screwed at the insurance company whims. I wish we all knew of a way to join together to stop this crap.

[FloridaJudy]

25. I just "love" how Big Pharma

Claims they need to keep prices high to pay for "research and development". Those companies pay almost twice as much on advertising than they do researching new drugs. The ultra-expensive medication may doctor prescribes me for asthma was developed in England, for crying out loud. And I'll the Brits don't have to choose between paying the rent and filling their prescriptions. Nor - I suspect - do they get bombarded by ads enjoining them to "Ask your doctor if Vitameatavegamin is right for you!"

[Liberal In Texas]

28. Not only that, much of the the R&D they do has to do with changing the

formula here or there to get a new patent on basically the same drug.

[lovuian]

26. this is getting ridiculous

I'm amazed Americans have lasted this long with paying for this crap