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Pending bill may assuage climbing Rx co-pays

September 20, 2010 12:00:00 AM PDT
More patients can't afford rising prescription co-payments, but a new bill may put a lid on the increasing price tags.Even with health insurance and a prescription drug plan, many patients are having trouble footing the bill when it comes to medication.

"I have a $700 co-payment," said patient Karen Mattson.

"They were charging us outrageous amounts," said another patient Glenda Dykstra.

Millions of people like Mattson and Dykstra who suffer from debilitating and life-threatening illnesses are facing the same situation of sky high, unaffordable prescription co-payment amounts.

Your policy dictates what you pay for prescriptions, and most people use a three-tier system. For example, you pay $15, $20 or $25, depending on the drug.

Now some health insurance companies are introducing a new tier for specialty drugs and charging patients much higher co-pays.

Physically and financially. Mattson said she racked up $20,000 in credit card debt paying high prescription co-pay costs.

"Dealing with the insurance, in many ways, is more stressful than the disease," said Mattson.

Dr. Jonathan Calkwood treats Mattson's multiple sclerosis and said many of his patients rely on drugs called, biologics, which prevent attacks and disability.

Many patients with MS, rheumatoid arthritis, HIV and cancer depend on biologics but they are among those drugs with climbing co-pays. Doctors acknowledge producing these specialty drugs costs more, but they point out that insurance companies could actually end up paying more if the patients can't afford their medicine and end up back in the hospital.

"If they're driving many people off their medications, that will come back to hurt them," Calkwood said.

There are no federal laws that protect patients from high prescription co-pay prices. Currently in the U.S. Senate, a bill is pending that would cap patient co-pays at $200 a month or $500 maximum, if they have more than one prescription. It's something that the Arthritis Foundation describes as critical.

"When you're faced with a chronic disease and making a choice between disability and bankruptcy, that is an unfair choice today in America," said Amy Melnick with the Arthritis Foundation.

Some drug companies do offer programs to help with the co-payment prices for certain prescriptions. Mattson was eligible for help with one medication. Medicare also has a program for people who meet certain income qualifications.

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