Drug cost-sharing and other wonkery…

Maggie Mahar and Niko Karvounis at Health Beat host this week’s Health Wonk Review. In addition to a better-than-the-original summary of our post on ER overcrowding, the blog hightlights lots of good issues and posts.

There’s lots of commentary (some compiled by Brass and Ivory) on the recent New York Times article by Gina Kolata (reprinted in the Sacramento Bee and elsewhere) about the astonishing co-payments and cost-sharing for a new “tier 4” class of prescription drugs.

Here’s the Wonk summary and links on this issue:

“…many insurers are now insisting that patients suffering from diseases such as MS, Hepatitis C and some cancers pay a percentage of the cost of super-expensive drugs.

Normally patients are asked to pay a flat fee of $10, $20, or $30, depending on whether an insurer classifies a drug as tier 1, tier 2 or tier 3. But now patients are forced to pay 20 percent to over 30 percent of the cost of “tier 4” drugs that can cost $100,000 a year—or more. Emrich presents the full range of responses coming from MS Bloggers, Health Policy Wonks, and Medical Professionals.

While some think that “Patients have been shielded from costs far too long, subsequently leading to an entitlement mentality,” others sympathize with MS bloggers like Jeri who writes: “I am terrified about what will happen when this Fingolimod trial ends and I no longer get my medication for free. I strongly believe that the medicine is the reason for this long period of remission that I am enjoying, and the health care system is putting a price on that for me. I know it will be out of my reach once it has gone to market and I am forced to pay for it.”

Meanwhile, at the Sentinel Effect, Richard Eskow quotes a surprising industry response from Robert Zirkelbach of America’s Health Insurance Plans: “When plan designs are no longer made to change behavior, but simply to transfer high-cost items back to the insured party, that’s risk transfer and not benefit design. As a result, the insurance concept is being subtly modified – and arguably undermined.” [Note: this, from an interview by American Prospects’s Ezra Klein.]

Lisa ends by tipping her hat to Merrill Goozner of GoozNews, re-printing Goozner’s post on tier 4 in its entirety.

At Colorado Health Insurance Insider, blogger Louise offers her own very sharp take on tier 4 drugs, and offers her solution for keeping costs down without imposing an unfair burden on a smallgroup of very sick patients. Her concluding paragraph deserves to be reprinted in full: “Charging insured [patients] slightly higher prices for common drugs – the ones that are prescribed to millions of Americans – and not having to charge dramatically higher prices for the rarely prescribed, expensive drugs would be a better way of spreading the rising cost of prescriptions out over the whole population, instead of dumping it at the feet of those who are already battling against some of the nastiest illnesses around.” Amen to that.

Finally, for Health Beat’s take on Tier 4, check out Maggie’s last post, where she asks “Who Sets the Price at $100,000” and, does anyone happen to know, “Are These Drugs Effective?”

Health Access California promotes quality, affordable health care for all Californians.

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