Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] Health insurers using drug coverage to discriminate

From the 28 January 2015 post at Engineering Evil – Intel Portal for Weighted Data and Information

In some US health plans, HIV drugs cost nearly $3,000 more per year than in other plans. If left unchecked, this practice could partially undermine a central feature of the Affordable Care Act.

Harvard School of Public Health

Boston, MA — Some insurers offering health plans through the new federal marketplace may be using drug coverage decisions to discourage people with HIV from selecting their plans, according to a new study from Harvard T.H. Chan School of Public Health. The researchers found that these insurers are placing all HIV drugs in the highest cost-sharing category in their formularies (lists of the plans’ covered drugs and costs), which ends up costing people with HIV several thousands more dollars per year than those enrolled in other plans.

The study appears online January 28, 2015 in the New England Journal of Medicine.

January 29, 2015 Posted by | health care | , , , , , , , , , , | Leave a comment

[Reblog] The Illogic of Co-Pays and Deductibles

From the 13 January 2015 post at Mike the Mad Biologist

Last week, the NY Times ran story about how the Harvard University healthcare plan is raising various employee costs in an effort to lower costs–this is partly a response to various Obamacare/ACA policies (boldface mine):

The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.

Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.

……

Why? If you’re sick and able to pay, you will get the treatment in most cases. It’s worth the money–being able to afford medical treatment is one reason people like having money. Most people just aren’t that cheap when it comes to their health. But if you’re unable to pay, you won’t get treatment–even if you need it. The latter will lower healthcare costs–less fortunate people won’t get treatment–but so would shooting sick people in the head. And if you don’t believe me, those radicals at the Boston Federal Reserve seem to think so as well.

January 20, 2015 Posted by | health care | , , | Leave a comment

Options when your drug copays are too expensive

Picture taken by myself of my Adderall prescri...

Image via Wikipedia

From a KevinMD.com article by LESLIE RAMIREZ, MD

You have insurance and, supposedly, it covers your medicines. However, you still get stuck with a portion of the bill that the insurance company calls a “copay.” In some cases these copays can run more than $150/ month per medication (e.g. Enbrel). If you are on more than one of these expensive, branded medications the copays can really add up. What are your options?

 1. Generic alternative. Always ask your doc if there is a reasonable generic alternative. This is always the best option for you in the long run. However, if there truly is no generic medication that comes close, then check into either (or both) of the next two options.

2. Drug specific copay programs. These programs are run by the manufacturers of the drugs, aka Big Pharma (BP). Usually, these discounts are given to all patients, regardless of income.  But make no mistake, it is a way for BP to circumvent your insurance company’s cost control mechanism for prescriptions. By picking up part or all of the cost of your copay, BP trying to make their product more attractive to you and to your physician. But when the manufacturer stops offering the copay discount programs you will be back to square one. However, if according to your doctor, you must be on one of these drugs, then by all means, take advantage of the savings while they last. In the case of Enbrel, the Enbrel Support Card Program picked up the tab for six months worth of copays. To find out more info on whether such a program exists for your medication, there are many websites out there, including the manufacturer’s site.

However, I found the following two websites particularly useful:

Internetdrugscoupons.com This website shows you all available drugs that have coupons, copay and otherwise,  associated with them. It’s an ugly little site, and ignore the annoying ads for a prescription savings card. But it couldn’t be simpler to use. And all the coupons I clicked on were still valid- so it seems like the folks behind it keep it up to date. According to the mission statement on the website “[The founder] assembled this database of drug coupons to make it easy for people like my elderly parents to save money on their medications.”

RxAssist.org This is a super slick website that allows you to look up your medicines, albeit individually, to see what deals are offered. When you see a deal you click on the medicine and you are directed to the manufacturer’s website. According to the About section of the website, RxAssist.org was established in 1999 with funding from The Robert Wood Johnson Foundation.

3.  Disease specific copay programs. There are many organizations that offer patients with specific diseases, such as cancer and HIV/AIDS,  assistance with their prescription copays. These programs often require financial ability-to-pay information from you to qualify for assistance. Disease Specific Copay Programs is a very comprehensive list of copay and other assistance programs compiled by a BP-funded site called Partnership for Prescription Assistance, aka PPArx.org.

Leslie Ramirez is an internal medicine physician and founder of Leslie’s List, which provides information that enables all patients, but especially the uninsured and underinsured, to find more affordable medications and health care services.

July 27, 2011 Posted by | Consumer Health | , , , , , | Leave a comment

   

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