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Author Topic: Co-Payments Go Way Up for Drugs With High Prices  (Read 6047 times)

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Online Miss Philicia

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Co-Payments Go Way Up for Drugs With High Prices
« on: April 14, 2008, 05:42:53 AM »
source
April 14, 2008

Co-Payments Go Way Up for Drugs With High Prices

By GINA KOLATA
Health 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.

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.

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.

Now Tier 4 is also showing up in insurance that people buy on their own or acquire through employers, said Dan Mendelson of Avalere Health, a research organization in Washington. It is the fastest-growing segment in private insurance, Mr. Mendelson said. Five years ago it was virtually nonexistent in private plans, he said. Now 10 percent of them have Tier 4 drug categories.

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.”

And often, patients say, they had no idea that they would be faced with such a situation.

It happened to Robin Steinwand, 53, who has multiple sclerosis.

In January, shortly after Ms. Steinwand renewed her insurance policy with Kaiser Permanente, she went to refill her prescription for Copaxone. She had been insured with Kaiser for 17 years through her husband, a federal employee, and had had no complaints about the coverage.

She had been taking Copaxone since multiple sclerosis was diagnosed in 2000, buying 30 days’ worth of the pills at a time. And even though the drug costs $1,900 a month, Kaiser required only a $20 co-payment.

Not this time. When Ms. Steinwand went to pick up her prescription at a pharmacy near her home in Silver Spring, Md., the pharmacist handed her a bill for $325.

There must be a mistake, Ms. Steinwand said. So the pharmacist checked with her supervisor. The new price was correct. Kaiser’s policy had changed. Now Kaiser was charging 25 percent of the cost of the drug up to a maximum of $325 per prescription. Her annual cost would be $3,900 and unless her insurance changed or the drug dropped in price, it would go on for the rest of her life.

“I charged it, then got into my car and burst into tears,” Ms. Steinwand said.

She needed the drug, she said, because it can slow the course of her disease. And she knew she would just have to pay for it, but it would not be easy.

“It’s a tough economic time for everyone,” she said. “My son will start college in a year and a half. We are asking ourselves, can we afford a vacation? Can we continue to save for retirement and college?”

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.

Medicare drug plans have to notify patients but, Mr. Mendelson said, “that doesn’t mean the person will hear about it.” He added, “You don’t read all your mail.”

Some patients said they had no idea whether their plan changed or whether it always had a Tier 4. The new system came as a surprise when they found out that they needed an expensive drug.

That’s what happened to Robert W. Banning of Arlington, Va., when his doctor prescribed Sprycel for his chronic myelogenous leukemia. The drug can block the growth of cancer cells, extending lives. It is a tablet to be taken twice a day — no need for chemotherapy infusions.

Mr. Banning, 81, a retired owner of car dealerships, thought he had good insurance through AARP. But Sprycel, which he will have to take for the rest of his life, costs more than $13,500 for a 90-day supply, and Mr. Banning soon discovered that the AARP plan required him to pay more than $4,000.

Mr. Banning and his son, Robert Banning Jr., have accepted the situation. “We’re not trying to make anybody the heavy,” the father said.

So far, they have not purchased the drug. But if they do, they know that the expense would go on and on, his son said. “Somehow or other, myself and my family will do whatever it takes. You don’t put your parent on a scale.”

But Ms. Steinwand was not so sanguine. She immediately asked Kaiser why it had changed its plan.

The answer came in a letter from the federal Office of Personnel Management, which negotiates with health insurers in the plan her husband has as a federal employee. Kaiser classifies drugs like Copaxone as specialty drugs. They, the letter said, “are high-cost drugs used to treat relatively few people suffering from complex conditions like anemia, cancer, hemophilia, multiple sclerosis, rheumatoid arthritis and human growth hormone deficiency.”

And Kaiser, the agency added, had made a convincing argument that charging a percentage of the cost of these drugs “helped lower the rates for federal employees.”

Ms. Steinwand can change plans at the end of the year, choosing one that allows her to pay $20 for the Copaxone, but she worries about whether that will help. “I am a little nervous,” she said. “Will the next company follow suit next year?”

But it turns out that she won’t have to worry, at least for the rest of this year.

A Kaiser spokeswoman, Sandra R. Gregg, said on Friday that Kaiser had decided to suspend the change for the program involving federal employees in the mid-Atlantic region while it reviewed the new policy. The suspension will last for the rest of the year, she said. Ms. Steinwand and others who paid the new price for their drugs will be repaid the difference between the new price and the old co-payment.

Ms. Gregg explained that Kaiser had been discussing the new pricing plan with the Office of Personnel Management over the previous few days because patients had been raising questions about it. That led to the decision to suspend the changed pricing system.

“Letters will go out next week,” Ms. Gregg said.

But some with the new plans say they have no way out.

Julie Bass, who lives near Orlando, Fla., has metastatic breast cancer, lives on Social Security disability payments, and because she is disabled, is covered by insurance through a Medicare H.M.O. Ms. Bass, 52, said she had no alternatives to her H.M.O. She said she could not afford a regular Medicare plan, which has co-payments of 20 percent for such things as emergency care, outpatient surgery and scans. That left her with a choice of two Medicare H.M.O’s that operate in her region. But of the two H.M.O’s, her doctors accept only Wellcare.

Now, she said, one drug her doctor may prescribe to control her cancer is Tykerb. But her insurer, Wellcare, classifies it as Tier 4, and she knows she cannot afford it.

Wellcare declined to say what Tykerb might cost, but its list price according to a standard source, Red Book, is $3,480 for 150 tablets, which may last a patient 21 days. Wellcare requires patients to pay a third of the cost of its Tier 4 drugs.

“For everybody in my position with metastatic breast cancer, there are times when you are stable and can go off treatment,” Ms. Bass said. “But if we are progressing, we have to be on treatment, or we will die.”

“People’s eyes need to be opened,” she said. “They need to understand that these drugs are very costly, and there are a lot of people out there who are struggling with these costs.”
   
"I’ve slept with enough men to know that I’m not gay"

Offline thunter34

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #1 on: April 14, 2008, 09:36:59 AM »
This is utterly disgusting.  There are many ways in which my country is shaming itself, and our so-called system of healthcare is one that is chief among them. 
AIDS isn't for sissies.

Offline pozniceguy

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #2 on: April 14, 2008, 10:15:06 AM »
I thought the whole purpose of "group" insurance plans was to "spread" the cost out over the larger group...that way whenever someone needed "large" payments there would be money available to pay for it......now when you separate the "benefits" to cost those who use the system to pay higher shares what actually happens to the money that others have paid in but are not making any claims????   ...whats next cancel you if you make a claim as some auto insurers do?????
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Offline Dachshund

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #3 on: April 14, 2008, 10:23:16 AM »
...whats next cancel you if you make a claim as some auto insurers do??

They already do that.

Offline David_CA

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #4 on: April 14, 2008, 10:37:44 AM »
This is screwed up.  If insurance companies weren't already making profits, they wouldn't be in the business.  Even though my drugs are expensive, the vast number of people at my place of employment do not have such expenses.  I wonder if this change will effect employees of the largest employer in NC...  State of NC employees?

David
Black Friday 03-03-2006
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Offline MSPspud

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #5 on: April 14, 2008, 10:39:01 AM »
I've been aware of this for a number of years as I watch my employer's various healthplans turn to percentage based co-pays.  In total we have 6 plans and only 2 of them have traditional co-pays now.  Each year I hold my breath in worry.  If this happens to me, my Plan B will be to reduce my 401K deductions and pump up my Health Spending Card.  My worry then, what would happen after the next wave of cuts?  

Online Miss Philicia

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #6 on: April 14, 2008, 10:47:04 AM »
It's TOTALLY  fucked up, especially as I'm quite sure HIV meds will get thrown into this formulary madness if they're not already.  I was a bit surprised that it wasn't mentioned in the article.

For a bit of perspective, I'm quite sure when I first went on meds in 1993 the maximum co-pay for anything was something like $8, and back then AZT was a price med.  And of course, it was pre-HMO and I could see whatever doctor I wanted.  HMO's were supposed to save patients money, or so we were told when they started implementing them in the mid-90's. 

It's all a massive racket like the mafia or something.
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Offline eclecticguy

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Tier 4 and tier 5 drugs
« Reply #7 on: April 14, 2008, 11:04:43 AM »
http://www.nytimes.com/2008/04/14/us/14drug.html?pagewanted=2&_r=1&hp

This article appeared today in the NY Times.  I'm in health care and have heard that insurance company's are trying to move to this type of copayment, but this is the first time I've seen it in a non-medical publication.  Basically, insurers are placing very expensive drugs into categories in which people will pay a percentage of the actual cost of the drug, rather than a copayment.  This article did not list HIV/AIDS meds as some of those being affected.  Has anyone run into this with their insurance company and their meds?
"Faith is blind trust in the absence of evidence, even in the teeth of evidence" -Sir Richard Dawkins (Darwin's Rottweiler)

Offline shadowfluid

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #8 on: April 14, 2008, 11:09:12 AM »
I am so not looking forward to getting insured anytime soon then.
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Feb 1 08    Start Truvada+Viramune
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Offline thunter34

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #9 on: April 14, 2008, 11:10:19 AM »
I am so not looking forward to getting insured anytime soon then.

In a way, this thread goes hand in hand for me with your other thread about the state of ADAP.  They speak of how people are using ADAP as a permanent health system instead of the temporary one it was meant to be.  I currently work only PT and collect meds free through ADAP.  That work load has been the same for me long about as long as I have been here on the boards.  It might sound silly to some of you reading this, but I confess that I've had a fear of going back to FT and possibly breaking the money limits and getting booted off the ADAP roles here.  I'm scared of getting snagged without access to meds - and that happens suddenly, immediately if there is ever a snag in the paper trail.  I'm scared of taking myself away from the government teet because I cannot afford for anything to happen with my supply of meds.  Not for very long, at least.  It's the same reason I'm afraid of relocating anywhere.  I'm afraid of doing anything that might somehow throw a wrench into my medical care.  I am scraping - SCRAPING - by right now by the skin of my teeth, but at least I know I have pills.  The company I work for does not offer very good health benefits, but I had to carefully select a new job that wasn't too  good when I got well enough to work again.  I didn't know how long my stamina was gonna hold up (and it didn't after awhile) and I knew that if I tanked there, I might very well be (on paper) out of eligibility for assistance for awhile.  Even in 2006, my salary skated real close to the cutting line and I got extremely nervous about it.  I hate being dependent on government care, but I don't feel any more secure about private insurance plans these days. 
AIDS isn't for sissies.

Offline Ann

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #10 on: April 14, 2008, 11:14:18 AM »
Eclecticguy,

I merged the thread you started in the Treatment forum with the already-existing thread on the same subject in Living.

Ann
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Offline mjmel

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #11 on: April 14, 2008, 11:55:03 AM »
...
It's all a massive racket like the mafia or something.
...

That sentence bears repeating.
But don't expect anyone to come to the rescue too soon. Not this President. Not this Congress.
US citizens: Change must come. So, don't despair to the point of not voting in November.
OK?
Mike

Offline BlueMoon

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #12 on: April 14, 2008, 01:18:45 PM »
I'm already on a plan like that.  Brand name drugs have a $25 copay ($50 for mail order), plus a 20% "coinsurance", plus a $500 annual deductible.  My first three-month supply cost over $1600, which is why I went through the aggravation of the state Drug Assistance Plan.  With the deductible out of the way, it would cost me about $470 a month to buy my meds at a local pharmacy.

The kicker is that within three months of my first HIV-related insurance claim, I received a letter from my insurance company stating that my policy will be changed to one that is "up-to-date" and "reflects today's health insurance environment".   ::)   Can't wait to see the details!  This is after years of paying premiums with only two minor claims, and never buying prescription drugs before. 
 
...................VL.....CD4.....%
-----------------------------------------
08/10-- ......<40.....290.....42
05/10-- ......<48.....290.....46
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Offline ademas

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #13 on: April 14, 2008, 01:34:07 PM »
That sentence bears repeating.
But don't expect anyone to come to the rescue too soon. Not this President. Not this Congress.
US citizens: Change must come. So, don't despair to the point of not voting in November.
OK?
Mike

I hear you, but I'm still not hearing much from any candidate that would offer real change.
Aren't both the dem plans basically working within the framework of our current system?

Offline thunter34

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #14 on: April 14, 2008, 01:38:57 PM »
I hear you, but I'm still not hearing much from any candidate that would offer real change.
Aren't both the dem plans basically working within the framework of our current system?


ademas' 1,000th post!  and it was discussing something all noble and stuff...not poopie and porn like most of us.
AIDS isn't for sissies.

Offline Desertguy

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #15 on: April 14, 2008, 02:30:15 PM »
I posted on the question of ADAP a few weeks back, I consider myself to be one of the lucky people on this site when it comes to co-pay.  I go thru the VA my Doc there used to be in private practice as a HIV specialist is purported to be one of the best in Las Vegas.
My co-pay for office visits is $15, & for perscriptions its $8.  I am on Atripla so I would be shocked I am sure if I had to use my Blue Cross Insurance for it.
So if any of you are Veterans look into the benefits of the VA.

Offline allanq

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #16 on: April 14, 2008, 03:28:40 PM »

The kicker is that within three months of my first HIV-related insurance claim, I received a letter from my insurance company stating that my policy will be changed to one that is "up-to-date" and "reflects today's health insurance environment".   ::)   Can't wait to see the details!  This is after years of paying premiums with only two minor claims, and never buying prescription drugs before.  

This is really scary. What is happening in this country? People unfortunate enough to be dealing with a chronic disease or just struggling to survive are being treated like disposable commodities. You can be sure that those changes that will make your policy "up-to-date" are going to be very unpleasant. They are not only making it more and more difficult for you to live but also telling you that it's being done to "reflect today's health insurance environment." Isn't it great to be up to date? They're not only putting the squeeze on us for more money but also insulting our intelligence! I'd prefer some simple old-fashioned understanding and compassion, but I guess that's just because I'm an old codger who doesn't care about being "up to date."

I qualify for treatment at the VA, but the so-called HIV specialist at my local VA clinic is useless. The last time I saw him, I asked him about some new drugs that were in the pipeline. He didn't have a clue as to what I was talking about. I guess that in a pinch I'll use the VA for my drugs and lab work and just make sure I keep up with HIV treatment issues (which is a good thing to do in any case).

Allan
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Online Miss Philicia

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #17 on: April 14, 2008, 04:19:52 PM »
Yeah, that's very odd in my past experience being HIV+ and having private HMO insurance, though of course policies differ widely and I've been off private stuff for 5 years now.  I'd run whatever you receive from them by an ASO case manager if you can.  Make sure you take them in a copy of whatever paperwork you go about your policy when you initially signed on to it.
"I’ve slept with enough men to know that I’m not gay"

Offline LordBerners

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #18 on: April 14, 2008, 04:26:48 PM »
It's all a massive racket like the mafia or something.

Absolultely right.  You've perfectly described 'private' health care.   And they have a gun to our heads.
Please, just call me Berners.. or Baron.

Offline pozattitude

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #19 on: April 14, 2008, 05:36:49 PM »
I have been very afraid of that.  My fellow coworkers  in the east coast are already experiencing something similar, the new prescription plan for my company makes you pay up to $2000.00 out of pocket before they start to cover the prescription, and once they start to pick up some of the cost, they will make you pay a percentage of the drug, no more copays.
If this happens to my plan next year I will quit my job and get a lower paying or part time job and go on ADAP.  This is so fucking sad because I am being forced to make a choice between keep working ,being productive  and not working so I can get my drugs..the bottom line is even though my job is not a horrible paying job, if the drug plan moves towards this new rules I will have a choice of paying rent of buying my meds and I can't afford both on this new plan.
I am really scared
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Online Miss Philicia

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #20 on: April 14, 2008, 06:33:02 PM »
Basically insurance companies are going to make it so that an HIV patient must earn a salary of $100,000/year or it's not worth working.  We've not even begun to factor in the costs paid on the medical care side (i.e. separate deductibles and co-payments and other out-of-hand costs).  Plus any portion of the insurance premium if the employer doesn't cover all of it.

Of course, I just pulled $100,000 out of a hat -- obviously that can be some other number, and will fluctuate wildly if you live in Manhattan or Idaho, but still you get what I'm saying.

It's quite sad -- and not to go back to the numbers I threw up for what I paid out of hand 15 years ago but I was also only earning $30,000/yr or so when I was diagnosed (I can't really recall but that sounds about right) AND that was living in Manhattan.
"I’ve slept with enough men to know that I’m not gay"

Offline dgr20002

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #21 on: April 14, 2008, 06:39:49 PM »
I don't know anything about the policy being "changed" but if it is an employers group plan I doubt it can be changed in the middle of the year. Especially not if it is going to cost you more. Companies have group enrollment towards the end of the year and what you elect is good for the next year unless you have a life changing event.

Evry year my company increases the amount of monthly co-pay just to be in the RX plan even if you do not get one prescription filled. Then for maintenance medications such as those for HIV you must use the mail order program. Currently tha's $100.00 for a three month supply of each medication and up to $200.00 for drugs not on the preferred list. Biotech prescriptions are limited to a 30 day supply and cost $100.00 every 30 days. I have no idea what biotech drugs are anyway and do not know if any HIV drugs fall into that category.

The best thing you can do for yourself is to get into a health care reimbursement account if available and plan out what you expect to pay for the year and put in as much as you can afford into that account. You are paying yourself back and lowering your taxes at the same time. I think 2K is the limit on the amount you can put in right now.

David

Offline thunter34

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #22 on: April 14, 2008, 06:51:50 PM »
I have been very afraid of that.  My fellow coworkers  in the east coast are already experiencing something similar, the new prescription plan for my company makes you pay up to $2000.00 out of pocket before they start to cover the prescription, and once they start to pick up some of the cost, they will make you pay a percentage of the drug, no more copays.
If this happens to my plan next year I will quit my job and get a lower paying or part time job and go on ADAP.  This is so fucking sad because I am being forced to make a choice between keep working ,being productive  and not working so I can get my drugs..the bottom line is even though my job is not a horrible paying job, if the drug plan moves towards this new rules I will have a choice of paying rent of buying my meds and I can't afford both on this new plan.
I am really scared

That's exactly what I was talking about in my earlier post above, hon.  And with ADAP roles in Georgia, there is no sliding scale if you cross the earings limit - a dollar over means all or nothing.  The meds alone for me are in the ballpark of $15k per year, and add to that doctor visits, labs, etc.  I'm somewhere in the $20-25k range for a year.  And I'm a cheap date when it comes to HIV. 
AIDS isn't for sissies.

Offline fearless

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #23 on: April 14, 2008, 07:20:24 PM »
The whole thing is really sad. It's unfortunate that it has had to come to this for you guys. The only potential up side I can see from this is that it may become the catalyst for real change. If the insured are now starting to get screwed in order to buy meds to keep family members alive, how long before there is a push for real change?
Be forgiving, be grateful, be optimistic

Offline bimazek

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #24 on: April 14, 2008, 07:29:56 PM »
i think the reason they dont do it with hiv meds is that hiv is an epidemic and if they made drugs too expensive then they would totally throw all medical ethics out the window because to not try to treat in an epidemic is too dangerous to get explosion of new cases, that is only reason i can think of, or that the activists who protested in 80s and 90s but that cant be it

any way perhaps this will help get univ hc

been to michaelmoore.com

good stuff there

i saw this article on FRont page top big headline in san diego republican newspaper

very shocking and depressing

makes it seem we will be forced into poverty or die

trying to live with disease


Offline J.R.E.

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #25 on: April 14, 2008, 08:01:35 PM »


All I can say, is something drastically needs to be done. I've been fortunate so far that my co-pay for HIV meds are $30:00 dollars each, for a total of 90.00 dollars a month) If something else happenned to me, where I needed some high priced drug, I am not sure how my current group insurance would cover it, or if they would make me be more responsible for the cost. All I know, is I wouldn't be able to afford it. Something needs to be done.


Ray
Current Meds ; Viramune, Epzicom, 40mg of simvastatin, 12.5mg of Hydrochlorothiazide.
Metoprolol tartrate 25mg



http://forums.poz.com/index.php?topic=40802.0

http://forums.poz.com/index.php?topic=45159.0

http://forums.poz.com/index.php?topic=39722.msg495621;topicseen#msg495621

http://forums.poz.com/index.php?topic=46806.0

http://forums.poz.com/index.php?topic=39414.msg491701#msg491701


 In October of 2003, My t-cell count was 16, Viral load was over 500,000, Percentage at that time was 5%. I started my first  HAART regimen  on October 24th,03.

 As of 6/4/14,  t-cells are at 423, Viral load <40

 Current % is at 13% 

  
 62 years young.

Offline pozattitude

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #26 on: April 14, 2008, 08:37:10 PM »
I just filed my taxes and i deduct all my medical expenses for credit...i pulled all my receits from my copays to doctor's , labs, the "surgery" and  my prescriptions...I spent almost $7k out of pocket for my health care  :o
I wondered where all my money was going?  if this is not bad enough...only imagine what a significant increase on the cost of my health care would do to me?  and not to mention that, although i had a very good review at work...they decided that I make enough and thus fore I did not get a raise  >:(

unfortunately the way i see the situation is simply the result of Corporate America taking over health care..it is a business and they are open to make money, we the sick are an obstacle in the way of the greedy to optimize their  profit and they are weeding us out...welcome to NEOCON AMERICA!
POSITIVE PEDALERS... We are a group of people living with HIV/AIDS, eliminating stigma through our positive public example.

Offline dgr20002

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #27 on: April 14, 2008, 08:42:51 PM »
I agree with the above. I saw something my company put out once that said of almost the 30K employees there are less than 100 costing the most in healthcare dollars. I am sure they know exactly who we are too.

David

Offline aztecan

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #28 on: April 14, 2008, 09:17:01 PM »
I just ran into this today. I know someone who had to switch to his employer's health plan. It is required here, if it is available. That said, he must pay 30 percent of the $1,700 his Atripla costs each month. That is more than $400. I know its not thousands, but still, its very tough. I have to explain this to him tomorrow.

I thought my situation was sorta bad because I pay $150 a month for my copays. At least that is less than the $400 this other guy will have to pay.

Luckily, we do have a reimbursement program here, so he will get it back each month through the Insurance Assistance Program. But I can see this is just the beginning.

Like the farce 401K savings plans are - and always have been - this trend among insurers does not bode well for us working stiffs.

HUGS,

Mark
« Last Edit: April 15, 2008, 12:10:21 AM by aztecan »
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline eclecticguy

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #29 on: April 14, 2008, 09:29:58 PM »
i think the reason they dont do it with hiv meds is that hiv is an epidemic and if they made drugs too expensive then they would totally throw all medical ethics out the window because to not try to treat in an epidemic is too dangerous to get explosion of new cases, that is only reason i can think of, or that the activists who protested in 80s and 90s but that cant be it

any way perhaps this will help get univ hc

been to michaelmoore.com

good stuff there

i saw this article on FRont page top big headline in san diego republican newspaper

very shocking and depressing

makes it seem we will be forced into poverty or die

trying to live with disease




This is sadly true and also perhaps a saving.  Insurance companies have typically been able to discriminate against diseases in which "relatively" few have been affected.  This is not the case with HIV.  Clearly, all of us posting here have a very wide assortment of policies, from great to bad.  However, because HIV affects so many people, if the insurance companies, in general, start to move HIV meds to tier 4/5 structures, there is going to be a massive political backlash.
"Faith is blind trust in the absence of evidence, even in the teeth of evidence" -Sir Richard Dawkins (Darwin's Rottweiler)

Offline eclecticguy

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #30 on: April 14, 2008, 09:34:13 PM »
I agree with the above. I saw something my company put out once that said of almost the 30K employees there are less than 100 costing the most in healthcare dollars. I am sure they know exactly who we are too.

David

They know exactly who we are. They don't know why we cost so much, but they aren't stupid.
"Faith is blind trust in the absence of evidence, even in the teeth of evidence" -Sir Richard Dawkins (Darwin's Rottweiler)

Offline thunter34

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #31 on: April 14, 2008, 09:37:17 PM »
The whole thing is really sad. It's unfortunate that it has had to come to this for you guys. The only potential up side I can see from this is that it may become the catalyst for real change. If the insured are now starting to get screwed in order to buy meds to keep family members alive, how long before there is a push for real change?

And that sums it up.  It's when it starts really biting Joe America in the ass that change will come - by forcible demand.  Once the call for care shifts from catch phrase to the cry of catastrophe.
AIDS isn't for sissies.

Offline thunter34

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #32 on: April 14, 2008, 09:43:22 PM »

This is sadly true and also perhaps a saving.  Insurance companies have typically been able to discriminate against diseases in which "relatively" few have been affected.  This is not the case with HIV.  Clearly, all of us posting here have a very wide assortment of policies, from great to bad.  However, because HIV affects so many people, if the insurance companies, in general, start to move HIV meds to tier 4/5 structures, there is going to be a massive political backlash.

Perhaps.  But it is no less absymal even if my own ass is saved - or rather, other pozzies currently covered by private plans.  The whole thing is simply inhuman.  And it flies totally in the face of what insurance is supposed to stand for - the collective pooling of funds to "insure" all of us from financial and physical disasters.  If it is happening to any of us - no matter what our specific maladies - it is happening to all of us, in my opinion.
AIDS isn't for sissies.

Offline Jody

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #33 on: April 14, 2008, 11:01:03 PM »
Everyone is so concerned and it would seem rightfully so.  New York state had a budget surplus last year unlike most states, thanks in large part to New York city, with Wall Street and tourism.  But I just read that in the first quarter this year it was stated that the top 20 taxpayers in the state, who contributed 520 million dollars in the first quarter of 2007 only coughed up 75 million in the first quarter of 2008.

Multiply that by 4 quarters and the deficit from last year is well over a billion dollars just from that source alone...Deficits could well be higher.  And the federal government is not helping nearly as much of course what with at least 12 BILLION DOLLARS A MONTH going to wars we cannot afford in Iraq and Afghanistan!!!

It is sad and depressing that so many are being priced out of life saving meds already and seemingly more to come.

Jody  :'(
"Wake up to find out that you are the eyes of the world".
 "Try to discover that you are the song that the morning brings."

Grateful Dead

Offline MOONLIGHT1114

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #34 on: April 14, 2008, 11:15:51 PM »
Well isn't this just the cherry on my sundae of a day?

Dammit all.
HIV+ since '93, 1/12 - CD4 785 and undet.   WOO-HOO!!

Offline aztecan

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #35 on: April 15, 2008, 12:19:22 AM »
The best thing you can do for yourself is to get into a health care reimbursement account if available and plan out what you expect to pay for the year and put in as much as you can afford into that account. You are paying yourself back and lowering your taxes at the same time. I think 2K is the limit on the amount you can put in right now.

David

I did that. I put the max in. I drained that account last month.  :'(

That means I will have to cough up $450 out of my own pocket to cover my copays between now and the start of the new fiscal year July 1.

I'll make it, but what about those who are squeezing out $450 a month in copays? A flex account isn't going to last a year even if they put the max into it. And, keep in mind, that also still comes out of your paycheck. That money may be pre-tax, but it is still part of someone's paycheck.

HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline Lis

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #36 on: April 15, 2008, 12:29:27 AM »
I feel your pain... I just had to pay 5000.00 for our new nifty HSA... the good news... I hit the limit.. and now I have 2008 to pay it off.. yes life is ..........life i guess
poz 1986....

Offline MitchMiller

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #37 on: April 15, 2008, 02:19:26 AM »
I think the insurance companies should look to cut costs by doing some practical rethinking about the nature of HIV.  Many HIV patients are basically healthy on HIV meds.  There's no reason why a healthy HIV patient should have to visit his/her doc every three months.  I think minute clinics should offer low cost, walk-in VL tests and write HIV prescriptions.  Obviously, if the patient has a problem, he/she should be able to visit their HIV doc at will.  If the VL comes up suspect, it should be repeated and then possibly a visit to the doc might be called for. 
I've been going to the HIV doc for five years now, every three months and have never even seen the doc.  I just see the PA, who is often scrambling to read my labs from three months prior.  This just seems like a big waste of $$$ that could be better spent helping patients that need better care and help to keep copayments down for everybody.

Offline Jeffreyj

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #38 on: April 15, 2008, 02:56:17 AM »
One can only hope this spurs such outrage that it will be the beginning of some huge change.

I agree with
Hunter.... This is INHUMAN. Maybe, just maybe, this will be the breaking point.

Health Care has to change, Period. Enough already.

I can't express my anger propery here, I wish I had the words.
Positive since 1985

Offline md

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #39 on: April 15, 2008, 03:00:57 AM »
I agree with the above. I saw something my company put out once that said of almost the 30K employees there are less than 100 costing the most in healthcare dollars. I am sure they know exactly who we are too.

But, of course, that is exactly how it should be ...

Everyone (all 30,000 of them) pays into the healthcare plan so that, if they happen to be unlucky enough to be one of the 100 or so people that end up with really high medical bills they will be covered.

That is how it is supposed to work!


Offline Jeffreyj

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #40 on: April 15, 2008, 07:05:04 AM »
This country needs some SERIOUS leadership on this issue.. The entire system is screwed up.

Where is the leadership?  What a huge disgrace. The wealthy live. The poor die.


Makes for a sad situation.
Positive since 1985

Offline Dragonette

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #41 on: April 15, 2008, 07:55:26 AM »
There is a poz American where I live who applied for Asylum on the ground that he will die back in the US given the state of the insurance system.

But I am wondering about the workers unions and patients unions, I don't see any difference between people when it comes to being affected by the insurance fiasco. Health insurance is a basic right, anyone can fall ill (in fact it's pretty certain sooner all later everyone will need something expensive from their insurance), anyone could have an accident tomorrow, so what are Americans waiting for? Maybe I'm naiive but does it matter if its HIV, cancer, diabetis, arthritis, or perfect health, don't people understand the implications of the current (degenerating) system, can't they go on a strike for their human rights? Maybe b/c its been broken down into so many different situations in different states and employers, people are only looking out for themselves? But don't they understand that it will reach them sooner or later?

BTW there is a privatization of the health system in Holland too, nothing compared to the USA and still a healthcare haven in comparison, but in the last 2 years NL is seeing some implications of mixing medicine and greed.
 
"If you keep one foot in yesterday, and one in tomorrow, you piss all over today". Betty Tacy

Offline allopathicholistic

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #42 on: April 15, 2008, 08:38:42 AM »
To the Marie Antoinettes sitting in their government offices and corporate towers I wish I could ask them "Do you think I should be punished for having an illness? If so, must the punishment be sssoooo egregious and trapping? Why not just put us in front of a firing squad a la Hitler?!"

Offline allopathicholistic

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #43 on: April 15, 2008, 08:41:41 AM »
But, of course, that is exactly how it should be ...

Everyone (all 30,000 of them) pays into the healthcare plan so that, if they happen to be unlucky enough to be one of the 100 or so people that end up with really high medical bills they will be covered.

That is how it is supposed to work!



Best post of the week!! Kudos to you!

Offline thunter34

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #44 on: April 15, 2008, 12:32:25 PM »
Private Health Insurance Must Go. 

http://www.phimg.org/V2/


Worth a look.
AIDS isn't for sissies.

Offline Cliff

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #45 on: April 15, 2008, 12:44:52 PM »
I think this is probably the beginning of the end for HMOs/PPOs and will hopefully prompt the first steps towards universal coverage.  HMOs/PPOs were created to control cost, but it's clear that they can't (or won't).  So there's no purpose in having them around, if they are going to shift more direct costs to patients/workers.

Offline eclecticguy

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #46 on: April 15, 2008, 09:05:26 PM »
I think this is probably the beginning of the end for HMOs/PPOs and will hopefully prompt the first steps towards universal coverage.  HMOs/PPOs were created to control cost, but it's clear that they can't (or won't).  So there's no purpose in having them around, if they are going to shift more direct costs to patients/workers.

You would think that "universal" coverage would be a great idea. Be careful what you ask for. While participating in medical research projects  I have been fortunate enough to travel to several countries with socialized medicine.  Patients in these systems do not have good things to say about them.  Additionally, income taxes go through the roof under these systems and seeing how wonderfully efficient our government is, god knows how bad this could become.  Is it really a good thing if the state provides our meds, but we're taxed so heavily, our life is reduced to sitting at home because we can't afford to do anything else? Additionally,when you REALLY need to see a doc or have a procedure done there's a six week wait.  Hope it's not serious...

Don't get me wrong. I think we should have truly universal coverage.  I just don't think our government can do it.

As for the private insurance sector,the people that are supposed to be tasked with taking care of people, they were the 21st most profitable industry in the world in 2006.  Anybody see a problem with this?
"Faith is blind trust in the absence of evidence, even in the teeth of evidence" -Sir Richard Dawkins (Darwin's Rottweiler)

Offline MitchMiller

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #47 on: April 15, 2008, 09:58:51 PM »
If I'm not too late... for those interested in this topic, watch PBS tonight.  There is a special called "sick around the world" that describes basic health services in other countries.  Usually shows like this are presented in a purely objective manner, to provide information to educate all of us.  I just watch a brief on the PBS news hour on the Japanese health system... quite informative and perhaps leaves some hope that we might be able to at least go that route.  They use private insurance and medical facilities, but the gov't sets the fees for EVERY procedure AND drug.  Seems to work really well for them.  Of course the US would have to make sure any agency that sets these fees is not influenced by politics... could be a hard trick to turn given this country's history.

If you can't watch it on TV, you can watch it online.  This may have been previously aired.. not sure.  http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
« Last Edit: April 16, 2008, 01:02:02 AM by MitchMiller »

Online Miss Philicia

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Re: Co-Payments Go Way Up for Drugs With High Prices
« Reply #48 on: April 15, 2008, 10:52:18 PM »
It's on again tomorrow at 12:30am fyi
"I’ve slept with enough men to know that I’m not gay"

 


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