Beacon-Journal: Sick, and paying for it; increasing departure from HC insurance ethic

From John Curry, April 16, 2008
Subject: Beacon Journal says it like it is!!!!!!!!!!

"To stick the sickest people with the highest costs when they have no options turns the notion of insurance on its head. It makes a cruel joke of the idea that smaller payments from everybody work to cover the sickest among us."

Sick, and paying for it

How drug pricing increasingly departs from the ethic of insurance

Published on Wednesday, Apr 16, 2008
Akron Beacon Journal

If more evidence is needed that the concept of health insurance has weakened dangerously, the drug pricing plans of health insurance companies should serve.

By now, most patients are familiar with the drug formularies insurers create to control the use and cost of prescription drugs for the patients they cover. The lists are classified in tiers, from the cheapest and most commonly prescribed to the most expensive and so-called specialty drugs. The tiers are supposed to guide patients and physicians to select the lowest-priced drug (usually with the lowest co-payment) that meets a specific medical need. Patients pay more for drugs at higher tiers, a disincentive if cheaper alternatives could be as effective.

There's merit in the practice, considering the pressure to contain health-care costs. The promise is lower out-of-pocket costs for patients, lower drug costs for insurers and lower premiums for companies and governments offering uniform benefits for the populations they cover, the sick and the healthy.

Unfortunately, the defensible rationale is eroding fast. The New York Times reported this week that insurers increasingly are taking differential pricing to a new level. They are instituting a pricing system that places the heaviest costs on patients whose health, and sometimes survival, depend on the affordability of top-tier drugs.

According to the report, patients with expensive diseases and conditions, for example, cancers, rheumatoid athritis, multiple sclerosis and hemophilia, are facing sudden and dramatic increases in co-payments as insurers seek to rein in their costs. In some cases, the patient share of a prescription has gone up to 20 percent and higher for medications that cost thousands of dollars a year.

Varied pricing is defensible — if cheaper substitutes are available for every drug an insurer classifies as top tier. Or if alternatives work effectively for every patient. Such is not the case. To stick the sickest people with the highest costs when they have no options turns the notion of insurance on its head. It makes a cruel joke of the idea that smaller payments from everybody work to cover the sickest among us.