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Covered California: Prescription drug co-payments

October 7, 2013 12:00:00 AM PDT
Hundreds of thousands of patients in Southern California need expensive prescription medications to treat chronic illnesses. But even for those with insurance, the co-pays are steep.Covered California: What you need to know

Even with health care reform, the cost of prescription drugs for many in California will still be unaffordable. For those with chronic illnesses such as heart disease, diabetes or cancer, experts say the cost might even be more.

For years he thought he just had back pain. Then doctors told 55-year-old Covina resident Greg McNeal, 55, he was suffering from multiple myeloma, a cancer in his bone marrow.

"When I got diagnosed, it was like a bomb. It hit me really hard," said McNeal.

What's hitting him even harder? Hundreds of dollars in monthly co-pays for drugs he needs to stay alive.

"I'm in trouble. I'm in deep trouble," said McNeal.

"Think about that: $600, $800, $1,000 per month of co-pays," said Dr. Cary Presant, a former president of the American Cancer Society.

Dr. Presant, author of "Surviving American Medicine," says new drugs have increased the cure rate for cancer by 20 percent. But that comes with a cost.

"The trend over the last five years has been to have higher co-pays for medications. The Affordable Care Act will probably -- we don't know for sure -- but probably result in higher co-pays for some of these drugs," said Presant.

The issue isn't just with new drugs: To offset costs, many insurance companies have moved drugs from "general" into the "specialty drug" category, often with unaffordable co-pays. And it varies from plan to plan.

For example: a drug like Tamoxifen used to require a $10 to $15 co-pay. Now it can cost a breast cancer patient hundreds of dollars per month.

But help is available.

"The patient has to talk to the doctor and say, 'I'm having problems with this co-pay, can you help me out?'" said Presant.

Presant says ask your doctor about drug samples and co-pay assistance programs from drug manufacturers. Also, some foundations give grants to help patients with medications. And organizations like the American Cancer society can help you find resources.

Greg McNeal is hoping a foundation will come through for him. Until then all he can do is wait and hope.

"Well, we'll see what happens. My life is at stake, so we'll see," said Presant.

Dr. Presant says the first place patients should look for help is at their doctor's office. Then look for organizations specific to your illness. For example, if you have heart disease, call the American Heart Association.

Covered California: What you need to know