Hepatitis c-Insurers raising co-pays for expensive drugs

Rather than a set co-pay of $5 to $100 a month, specialty tiers require patients to pay "co-insurance" of typically 25 percent to 33 percent of the total cost. A patient taking the hepatitis C drug Pegasys costing $2,400 a month could face co-insurance of $600 to $800.

Insurers raising co-pays for expensive drugs

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Health insurers are increasingly charging patients sharply higher amounts for the most expensive drugs, often causing sticker shock for the sick people who need them.Health plans that have hiked co-payments say affected patients must pay hundreds of dollars more per month for drugs that can cost thousands, in order to prevent big jumps in premiums for everyone else.

But patients and their advocates say the practice discriminates against people who are unlucky enough to have a disease that is expensive to treat, and forces some to stop taking life-saving medicine. Three reports out this month say the practice can devastate patients financially.Florida has been hit hard, with its large population of seniors and a high proportion of younger patients with HIV, hepatitis, kidney disease and other chronic conditions that are treated with expensive medicines. One estimate says 12 percent of Florida prescriptions — and growing — are affected by the cost hikes.

Randall Rabbitt, a Delray Beach sales manager for an auto warranty firm, felt the co-pay shock. He had been paying $50 a month for Actemra, an intravenous drug for the crippling effects of rheumatoid arthritis, in which the body's immune system attacks his joints.
Then in June, with no notice, the insurer raised his share to $498."I scraped up the money. But I'm not in position to pay $498 a month," Rabbitt said. "That's on top of the $632 a month we pay for the premium. My family can't afford that. I may have to stop taking it."If I'm not on this, I literally have severe neck pain every day, to the point where I can't lift my head. My hips and ankles, I can't walk," Rabbitt said. "It makes all the difference between being able to do something or not. I'd have to go on disability and then what life would I have?"What happened?

The PPO at his job moved the drug into a "specialty tier," a co-pay class typically reserved for pills and IV drugs costing more than $600 a month — such as Rabbitt's Actemra at $1,100 to $2,100 a month.

Rather than a set co-pay of $5 to $100 a month, specialty tiers require patients to pay "co-insurance" of typically 25 percent to 33 percent of the total cost. A patient taking the hepatitis C drug Pegasys costing $2,400 a month could face co-insurance of $600 to $800..... Continue Reading...