- As you may know the current administration has been pushing
for privatization of Medicare, other changes in the health care, including
both the pharmaceutical and health insurance industries.
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- The first noticeable efforts came along with the idea
for health savings accounts. Changes in Medicare try to push recipients
toward HMO participation instead of traditional fee-for-service plans.
Employer health plans and state sponsored health plans consistently move
toward higher co-pay and deductible amounts in the policy.
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- When the Medicare Plan D drug program for seniors was
devised, the clear writing on the wall was that this plan was nothing more
than a profit machine for industry cronies at the expense of older and
disabled citizens.
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- Now you see, as addressed in this article, a new plan
to gouge more money from those with less disposable income, because they
have a chronic illness or one that they believe the only answer is a specific
drug. That drug may be one not perfectly tested with unknown side effects
or potential for damage. That drug also may be one that contains genetically
engineered compounds with long-term or yet unknown problems. No other options
are offered.
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- Here are some facts about the pricing structure of drugs
referenced for this NYT article. If any of the drugs on this list are
being prescribed for you please make sure that the doctor prescribing them
has fully educated you on the risk and benefit of these drugs, as is required
by law. You can review side effects and warnings at Rxlist.com:
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- Procrit $1024 / 6 vials depending on dose
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- Neupogen $4700 / 10 prefilled syringes depending on dose
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- Actimmune (Gamma interferon B1) $600-900 + per dose
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- Cerezyme, Fabrazyme $200,000 annually, for life. A GMO
drug, not unlike most on this list, made in cells of Chinese hamsters.
-
- "Pharma recommends more drug than may actually be
needed. This does not apply just to Cerezyme, but the Epo products (Amgen
& J&J), Avastin (Genentech.)
- Pharma goes to the FDA with doses that they think are
appropriate by virtue of clinical trials. To go with a low dose could
doom the drug to failure. It takes further data to lower the dose and the
companies are not stupid and want to keep their revenue up! In the case
of Cerezyme the dose started at much higher levels costing over 1 million
dollars are year at the recommended dose. The fact that we are now at $300K
means there may be more "wiggle room" dosing wise but it depends
on the patient's response. That will be the treating Doc's decision and
not the patient or regulators. Pharma is doing what they think is best,
of course looking at the bottom line, but it ultimately falls on the treating
physician."
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- Intron A, Intron A with Diulent, $600-900+ per dose
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- Avonex, Betaseron, Copaxone $1800 / 4 doses
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- Humira, Remicade $1800 / 2 doses
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- Here are some natural approaches that may help, with
less cost and less risk of harm:
-
- Anemia: Vitamin B12 injection. This is also helpful
to reduce hypertension in women.
-
- Cancer: Vitamin B12, IV Vitamin C, other -
-
- Chronic Granulomatous Disease: Zinc, Vitamin C, Sesame
Seeds, Natural anti-fungal herbs and/or pure essential oils
-
- Gaucher's Disease/other: Liposomal enzymes such as those
developed by and used in The Kelley Method.
-
- Hepatitis C IV Vitamin C, Milk Thistle, other
-
- MS Avoid aspartame, other -
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- Rheumatoid Arthritis: Niacinamide, Food allergy testing
(wheat allergy is usually prominent), other
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- NONE OF THE ABOVE INFORMATION IS PRESENTED FOR OTHER
THAN EDUCATIONAL PURPOSES.
-
- Should you wish to inquire about our investigative method
to assist you in understanding your unique metabolism and evaluation organ
system nutritional deficiencies, please contact us.
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- Co-Payments Soar for Drugs With High Prices
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- By Gina Kolata, April 14, 2008
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- 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.
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- 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.
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- The system means that the burden of expensive health
care can now affect insured people, too.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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."
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- Traditionally, the idea of insurance was to spread the
costs of paying for the sick.
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- "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."
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- And often, patients say, they had no idea that they would
be faced with such a situation.
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- It happened to Robin Steinwand, 53, who has multiple
sclerosis.
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- 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.
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- She had been taking Copaxone since multiple sclerosis
was diagnosed in 2000, buying a 30 days' supply at a time. And even though
the drug costs $1,900 a month, Kaiser required only a $20 co-payment.
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- 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.
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- 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.
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- "I charged it, then got into my car and burst into
tears," Ms. Steinwand said.
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- 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.
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- "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?"
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- 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.
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- INCLUDEPICTURE http://graphics8.nytimes.com/images/2008/04/13/us/drugmap.jpg"
\* MERGEFORMATINET
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- 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."
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- 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.
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- 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.
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- 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.
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- Mr. Banning and his son, Robert Banning Jr., have accepted
the situation. "We're not trying to make anybody the heavy,"
the father said.
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- 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."
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- But Ms. Steinwand was not so sanguine. She immediately
asked Kaiser why it had changed its plan.
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- 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."
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- 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."
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- 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?"
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- But it turns out that she won't have to worry, at least
for the rest of this year.
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- 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.
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- 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.
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- "Letters will go out next week," Ms. Gregg
said.
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- But some with the new plans say they have no way out.
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- 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.
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- 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.
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- 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.
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- "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."
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- "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."
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- Copyright 2008 The New York Times Company
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- __________________
-
- "This country, with its institutions, belongs to
the people who inhabit it. Whenever they shall grow weary of the existing
Government, they can exercise their constitutional right of amending it
or their revolutionary right to dismember or overthrow it." Abe Lincoln
Inaugural Address 1861
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- "America will never be destroyed from the outside.
If we falter and lose our freedoms, it will be because we destroyed ourselves."
Abe Lincoln
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