A new article highlights how health insurance companies are charging patients more for expensive prescriptions and blames health insurers for those high costs.
Only that’s not the entire story.
In recent years, pharmaceutical companies have produced advanced drugs that treat HIV, types of cancer, arthritis and other illnesses. These specialty drugs are expensive – some equaling the cost of a very nice car (think Jaguar).
But how do people afford these drugs? Typically most of the costs are have been picked up by health insurers and employers. Unfortunately, as more drugs enter the market the costs continue to increase.
So, what is happening now is that health insurers and employers are passing more of the cost to the consumer in the form of prescription tiers.
Prescription tiers charge consumers a different amount depending on the type and cost of the prescription.
Here is an example of a prescription tier:
Tier one: Generic drugs at a low copayment ($10)
Tier two: Brand-name drugs at a copayment ($30)
Tier three: Non-preferred brand-name drugs at a copayment ($50)
Tier four: Specialty drugs with high copayments ($150) or a 10 to 30 percent co-insurance rate
Why are prescription tiers necessary? These tiers help keep the premium costs down for other employees and consumers. If health insurers couldn’t charge consumers more for expensive medications, those costs would be passed on to the other policyholders and result in higher premiums.
Unfortunately, lawmakers are taking this issue up with health insurers and trying to contain what health insurance coverage can charge consumers for their prescriptions. But there are two issues with this logic:
- Prescriptions costs will still continue to increase by pharmaceutical companies – not health insurers.
- Requiring health insurers to cover more of the prescription cost will result in higher premium costs, which is an ineffective approach.
On the flipside of this debate is a whole different problem: When charged higher copayments and costs for prescriptions, consumers are more likely to not take the medication. Obviously the health care industry should be doing everything it can to keep costs affordable and promote adherence to prescriptions.
Who do you think should be blamed for high health insurance costs?
The health insurance companies or the pharmaceutical companies?