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unusualmusic_lj_archiveHealth 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.
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.
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.
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.”
...
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
Daily Kos breaks down the absolute lunacy of this:This reality has hit a nerve. I'm not surprised. It's frightening to read about an anonymous citizen who's losing access to a drug that is quite literally keeping her alive. You know that it's only a matter of time until someone in your own family faces the same insurance industry grim reaper in a business suit.
Just Pay Your Taxes--and shut-up:
Not to digress, but it's April 14th, I just mailed my taxes. Did you? Everyone I know is talking about their taxes. You know what they're saying and asking? I'll tell you. They're wondering what do we get for our tax dollars? Everyone knows that we're the only Western nation where healthcare is a privilege, not a right. Stupid us.
In every other civilized nation, taxes fund single-payer healthcare--but not here. But we just keep paying, stupid us. Don't forget as you wait on a long slow line at the post office, that your money is paying for heavily taxpayer subsidized Congressional health benefits. That's right, healthcare for them, but not for us. Stupid us.
In the United States we find all the money we need to occupy and destroy a sovereign nation, but providing basic healthcare to all our citizens is an expense we just can't afford. Stupid us.
Class Warfare, and Yes, I'm a very Bitter American:
Back to the New York Times, this is from today's paper. It proves beyond a shadow of a doubt that the scum at AHIP are setting up a huge class warfare endgame.
Here's how it goes. If health insurers pay for the expensive medication of your very sick neighbor, then your insurance premium will go up.
So let's just pit neighbor against neighbor, American against American. Cancer patients against the still healthy.
Please take note of the record earnings this year by some insurance companies highlighted in the article.
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.
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.
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.
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.”
...
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
Daily Kos breaks down the absolute lunacy of this:This reality has hit a nerve. I'm not surprised. It's frightening to read about an anonymous citizen who's losing access to a drug that is quite literally keeping her alive. You know that it's only a matter of time until someone in your own family faces the same insurance industry grim reaper in a business suit.
Just Pay Your Taxes--and shut-up:
Not to digress, but it's April 14th, I just mailed my taxes. Did you? Everyone I know is talking about their taxes. You know what they're saying and asking? I'll tell you. They're wondering what do we get for our tax dollars? Everyone knows that we're the only Western nation where healthcare is a privilege, not a right. Stupid us.
In every other civilized nation, taxes fund single-payer healthcare--but not here. But we just keep paying, stupid us. Don't forget as you wait on a long slow line at the post office, that your money is paying for heavily taxpayer subsidized Congressional health benefits. That's right, healthcare for them, but not for us. Stupid us.
In the United States we find all the money we need to occupy and destroy a sovereign nation, but providing basic healthcare to all our citizens is an expense we just can't afford. Stupid us.
Class Warfare, and Yes, I'm a very Bitter American:
Back to the New York Times, this is from today's paper. It proves beyond a shadow of a doubt that the scum at AHIP are setting up a huge class warfare endgame.
Here's how it goes. If health insurers pay for the expensive medication of your very sick neighbor, then your insurance premium will go up.
So let's just pit neighbor against neighbor, American against American. Cancer patients against the still healthy.
Please take note of the record earnings this year by some insurance companies highlighted in the article.
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no subject
Date: 2008-04-15 12:59 pm (UTC)