The Respectfully Republican Conversation

Don't know if any of you saw this.

No matter if you are a Democrat or Republican our Government is going to have to deal with this issue or the consequenses will be dire.
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Co-Payments Go Way Up for Drugs With High Prices
By Gina Kolata
The NY Times
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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.

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.

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?"

Although Kaiser advised patients of the new plan in its brochure that it sent out in the open enrollment period late last year, Ms. Steinwand did not notice it. And private insurers, Mr. Mendelson said, 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, Mr. Mendelson said, "that doesn't mean the person will hear about it." He added, "You don't read all your mail."

Some patients said they had no idea whether their plan changed or whether it always had a Tier 4. The new system came as a surprise when they found out that they needed an expensive drug.

That's what happened to Robert W. Banning of Arlington, Va., when his doctor prescribed Sprycel for his chronic myelogenous leukemia. The drug can block the growth of cancer cells, extending lives. It is a tablet to be taken twice a day - no need for chemotherapy infusions.

Mr. Banning, 81, a retired owner of car dealerships, thought he had good insurance through AARP. But Sprycel, which he will have to take for the rest of his life, costs more than $13,500 for a 90-day supply, and Mr. Banning soon discovered that the AARP plan required him to pay more than $4,000.

Mr. Banning and his son, Robert Banning Jr., have accepted the situation. "We're not trying to make anybody the heavy," the father said.

So far, they have not purchased the drug. But if they do, they know that the expense would go on and on, his son said. "Somehow or other, myself and my family will do whatever it takes. You don't put your parent on a scale."

But Ms. Steinwand was not so sanguine. She immediately asked Kaiser why it had changed its plan.

The answer came in a letter from the federal Office of Personnel Management, which negotiates with health insurers in the plan her husband has as a federal employee. Kaiser classifies drugs like Copaxone as specialty drugs. They, the letter said, "are high-cost drugs used to treat relatively few people suffering from complex conditions like anemia, cancer, hemophilia, multiple sclerosis, rheumatoid arthritis and human growth hormone deficiency."

And Kaiser, the agency added, had made a convincing argument that charging a percentage of the cost of these drugs "helped lower the rates for federal employees."

Ms. Steinwand can change plans at the end of the year, choosing one that allows her to pay $20 for the Copaxone, but she worries about whether that will help. "I am a little nervous," she said. "Will the next company follow suit next year?"

But it turns out that she won't have to worry, at least for the rest of this year.

A Kaiser spokeswoman, Sandra R. Gregg, said on Friday that Kaiser had decided to suspend the change for the program involving federal employees in the mid-Atlantic region while it reviewed the new policy. The suspension will last for the rest of the year, she said. Ms. Steinwand and others who paid the new price for their drugs will be repaid the difference between the new price and the old co-payment.

Ms. Gregg explained that Kaiser had been discussing the new pricing plan with the Office of Personnel Management over the previous few days because patients had been raising questions about it. That led to the decision to suspend the changed pricing system.

"Letters will go out next week," Ms. Gregg said.

But some with the new plans say they have no way out.

Julie Bass, who lives near Orlando, Fla., has metastatic breast cancer, lives on Social Security disability payments, and because she is disabled, is covered by insurance through a Medicare H.M.O. Ms. Bass, 52, said she had no alternatives to her H.M.O. She said she could not afford a regular Medicare plan, which has co-payments of 20 percent for such things as emergency care, outpatient surgery and scans. That left her with a choice of two Medicare H.M.O's that operate in her region. But of the two H.M.O's, her doctors accept only Wellcare.

Now, she said, one drug her doctor may prescribe to control her cancer is Tykerb. But her insurer, Wellcare, classifies it as Tier 4, and she knows she cannot afford it.

Wellcare declined to say what Tykerb might cost, but its list price according to a standard source, Red Book, is $3,480 for 150 tablets, which may last a patient 21 days. Wellcare requires patients to pay a third of the cost of its Tier 4 drugs.

"For everybody in my position with metastatic breast cancer, there are times when you are stable and can go off treatment," Ms. Bass said. "But if we are progressing, we have to be on treatment, or we will die."

Saluki...that article really pisses me off, (drug prices) I can't even think where to begin because I would sound like a blundering idiot! McCain better take a hard look at healthcare or it will be his own damn fault if he loses.

My onc told me that Arimidex will be generic next year.  We'll wait and see.  However, that doesn't mean it will be cheap!  And I have to reach a $2200 deductible before they will pay towards my mail order prescriptions or pay towards docs (except for a couple of well checkups).

ConsumerLab just had something about generic Toprol XL which I take.  About it being not so good.  But one has to join before one can read the report.  I think I'm finally going to have to join.  Also, they tests many supplements.

Something has got to be done.  And I do get so tired of watching these lawyers (ambulance chasers) advertise on television about suing for injuries.  I wouldn't go to them..that's for sure!

PS --The only Republican signs that I saw today were for Ron Paul. LOL

Here starts the republican negative ads.  Though McCain wants to stop them:

http://www.mcclatchydc.com/election2008/story/34699.html

LOL Susie.  He's gonna send the undertaker to be Osama.  LOL

Shirley

I think his endorsement for either candidate will determine how those 18 should vote at the convention.  It's an honor thing to vote, at least in the first round of voting, for the candidate you signed up to support, then your released.  Something like that.  Or, he can just release them to vote however they wish. 

Our State makes us sign a paper saying we'll vote for the candidate we were chosen to vote for.  It doesn't say anything more then that.

This is a disgrace and I had no idea that practice was going on, and to even have to legislate against a Dr. to keep him/her from doing such a terrible thing, it is beyond sickening. 

This has been going on for years.  Anyone that could let a baby die either by "tabling" the baby by throwing it on a shelf, or by killing him/her in a different method is just plain sick.  How 'bout the oath these doctors took? 

I wasn't ready for my third child.  In fact I wasn't ready for another child PERIOD!  It was our fault I got pregnant at 8 months after our second child was born.  And let me tell you something, I AM SO GLAD WE HAD HER!!!!!!!!!  And we couldn't "afford" her.  I tease her about being my "unwanted" child.  LOL  No wonder she and her dh have been traveling for over two years through Africa and still plan to continue taveling after they write their book. 

Unless you have a child you cannot understand the love.  And then when you have that second child you're afraid there won't be enough love to go around.  Oh, so untrue.

Okay, I'm going to say it.  I'm Pro-life.  Don't hate me cuz if you choose to be Pro-choice it wouldn't make me think less of you.  I have a dear friend who had an abortion many years ago because her dh (damned husband) was going to leave her for another woman and told her if she got an abortion he'd stay.  They went out of town for the abortion (he is well known around here).  He left!  He lied!  And to this day I know my friend has not told another soul about this.  We never talk about it.  I don't think any less of her and I love her to pieces.

Shirley

Shirley no need to apologize.......I am very pro life..........I'm not sure why we need to apologize for being in that position..........many years ago conservatives were concerned when Roe vs Wade was passed that abortions would be used for birth control which is exactly what has happen.......they were to be used when the mother's health was at risk........baby was not viable....rape and incest......but many women use abortion as a expensive way for birth control...........it's just so sad.........Shokk

There are other "present" votes on other sensitive issues that haven't seen the light of day yet.  The N.Y. Times had a long piece on those votes, about 6 of them, but didn't explain what they were.  We now see one of them.

If that is his view, I wonder why this has only come out now?  Why didn't Hillary bring this out way back when?  I can see that McCain would not want it out ... he wants Obama to run against, not the Clintons!

Why is this just coming out now?  The press must be aware of this story.  They are afraid to say anything about his past voting record, why?  I get more info from the internet and Susie, then the press will ever report.