Health Insurance--Part 2

Last month, I talked about my unhappiness that so many people are excluded from potentially life-saving diagnostic procedures, like colonoscopies, because of cost.

I had brought to my attention an article in the New York Times yesterday, "Co-Payments Soar for Drugs With High Prices." The articles talk about how insurance companies are creating fantastically high co-payments for some of the new, very expensive drugs which can save lives or slow the progress of diseases. One example was of a woman who was prescribed Copaxone for multiple sclerosis. Her husband's insurance company, Kaiser Permanente, had been charging a $20 co-pay for several years. But, when she went to refill the prescription in January, her co-pay jumped to $325 for one month.

Another case was of a man who was presribed Sprycel to control his chronic leukemia--a condition my father had. (I have no idea what he was prescribed.) Sprycel blocks the growth of the cancer cells. He had what he thought was good insurance through AARP, but his 90-day co-payment is over $4,000!

(I checked through my plan's website to see what it would charge. The news on Copaxion was better, if not good: $451.61 for 90 days. For Sprycel, the co-payment for 90 days is $3,255.53, not much better than the AARP insurance in the story. My company has a mail order pharmacy at a flat rate of $35 for 90 days and listed it as an option for Sprycel. But not every plan has mail order.)

This practice, called "Tier 4" and "Tier 5" (for even more expensive stuff) is designed to shift the cost of the most expensive drugs to the patients that use them, sparing the rest of us any need to support them. Isn't the idea of insurance to pool costs so that we share the costs among us? I'm convinced that something about universal medical care coverage needs to be done. One of my co-workers is opposed because that will erode our current fairly privileged position. I can live with that to a degree if that will help situations like these.

Don't assume that your insurance, when you do have it, won't slide "Tier 4" pricing in on you. If you have any choices, look carefully at drug coverage. And, if you have choices, be thankful that you do... and stop to think of those who don't.