The price of prescription medicine is going up for some patients. Insurance companies are passing on extra fees for high end drugs to the people who are using them. But what does this really mean for patients?
The cost of prescription medication would be out of reach for many families if it wasn't for insurance.
Kamal Muilenburg, a health care advocate, says she would be bankrupt if she didn’t have insurance. But Muilenburg is able to afford her chemo drugs because she is insured and makes a regular co-pay.
"Every health plan has their own set of co-pays. Almost all of them use three tiers of co-pays so the lowest being the generic," says Muilenburg.
That's followed by preferred brand-name drugs and then non-preferred brand-name drugs each requiring its own gradually rising co-pay amount.
But Muilenburg says some insurance companies have added a fourth payment tier, not based on a fixed amount but on a percentage of the actual cost of the drug, drugs that can add up to tens of thousands of dollars in a year.
"Well it's sort of a double whammy on those who need it the most. Because the people who are taking the most expensive drugs tend to be the ones with serious illnesses, or chronic illnesses, these are drugs that are keeping them alive today," says Muilenburg.
While some people are struggling with higher co-pays, all this could change in a couple of years, when the federal Affordable Healthcare Act goes into effect.
In the mean time, some states are trying to cap out-of-pocket expenses for prescriptions and other medical costs. Medical advocate Muilenburg says helping families pay for prescriptions will also help them survive.
"And if you don't take these drugs regularly, your cancer comes back, or you get sick, or you die," says Muilenburg.
These specialty drugs are often used for chronic conditions like cancer, HIV, MS, and kidney disease.
According to one report, 57 million Americans rely on specialty drugs.
These medications account for about 1% of total drug use, but 17% of drug spending.
