Imagine that most co-pays, even for branded drugs were typically $20-50 per monthly prescription, making them pretty much affordable, even for multiple prescriptions if you had asthma, heart disease and hypertension for example.
Imagine a change where many branded drugs were down graded from Tiers 1-3 to Tier 4 or 5. Now the same patient may be faced with a bill of 20-20% of the actual cost. This way, the plans are moving a greater proportion of the costs across to patients. It doesn’t sound much but consider if the 90 day bill for asthma drugs weent from $75 to $375 or a cancer therapy for a form of leukemia costing 33% of the $13,500 bill ($4,500) for 90 days supply. Ouch!
The asthma patient might decide that a couple of hundred dollars is a fair price to pay for remaining loyal to an inhaler that works for them and keeps their disease under control. A cancer patient, faced with a several thousand dollar bill, for the new targeted therapies such as Sutent and Nexavar for renal cancer or Sprycel and Tasigna for a form of leukemia (CML) might decide that is too much and seek alternatives.
The NY Times reported on this issue – LINK.
The worrying thing is whether this strategy is going to create a two-tiered system in America, where only the rich can afford the best drugs available to treat diseases such as cancer, rheumatoid arthritis, multiple sclerosis etc.
The US Government has spent billions fighting a war in Iraq; surely Americans who need medical care deserve better treatment than this?