DRUG COSTS: Consumers’ Copays On The Rise
Soaring prescription drug costs are prompting many health plans and employers to shift more costs to consumers, the Wall Street Journal reports. "We are trying to manage costs so we can continue to provide a drug benefit," said Alex Gelderman, director of clinical services for Pacificare Health Systems Inc. in Santa Ana, CA. Cigna Corp. has adopted a triple-tiered pricing scheme that charges patients $5 to $10 for generic drugs, $15 to $20 for brand name medicines on the plan's formulary and $35 to $40 for medicines not included on the list. Allen Schaffer, a vice president at Cigna Corp., said, "We found that the flat copayment isolated members from the financial consequences of choice." The Journal reports that the tactic of raising copays is a strategy on the part of HMOs "to pressure pharmaceutical companies into slashing prices."
Some are concerned that setting prices too high could discourage patients from taking necessary medications, driving up hospital costs in the process. "We have to be careful not to make shortsighted decisions in the attempt to control one segment of costs and forget to look at what the impact is on other medical costs," said Michigan Blue Cross' Marianne Udow. Others worry that higher copays lead to inequity in the system. Becky Cherney, president of the Central Florida Health Care Coalition, an Orlando employer group, said, "Those who make more money would have better access to drugs than those who make less. Our job as employers is to provide access to health care for everyone." The Journal reports that "more than 20 states are poised to debate bills this year that would inhibit health plans from keeping drugs off approved lists as a cost-control technique." (Winslow, 1/12).