An Insurance Change Drives Up The Price
Until this year, Tim K., 45, never had to think much about the cost of medication. He had no annual deductible and just a $30 co-pay when he filled his monthly prescription for Humira, a drug he takes to treat rheumatoid arthritis. Without insurance, it could cost about $5,000 a month.
So he was devastated to learn that his employer had switched insurance plans for 2018. His new co-pay was $100. More troubling, he now had a $1,500 deductible to pay before insurance kicked in. “It’s like I took a huge pay cut,” says Tim, who asked not to be fully identified for fear of retaliation by his employer. “It’s Outrageous.”
WHY IT HAPPENS
In an effort to deal with rising healthcare costs, many employers now require workers to sholder a larger percentage of their medical expenses, including drugs. In 2017 more than 40 percent of Americans with private insurance were enrolled in high-deductible plans, meaning they had to pay at least $2,600 for a family and $1,300 for an individual, out of pocket, before insurance kiked in. In 2010 just 25 percent of those with private insurance had that kind of plan.
Tim searched for manufacturer coupons on the website for AbbVie, the company that makes Humira. He found discounts that, over a full year, could save him at least $1,600.
To see whether a drug-maker offers discounts for an expensive medication you take, check its website or go to medicare.gov/pharmaceutical-assistance-program/
Another option for people with high-deductible plans is to look into health savings accounts, or HSAs. They allow people to spend up to $6,900 a year in tax-exempt dollars on out-of-pocket medical expenses.
Arranging for manufacturer coupons can be complicated and time-consuming and you should check with your insurer to see whether a coupon will count toward meeting your deductible and out-of-pocket maximum. In addition, people on Medicaid or Medicare or living in California might not be able to use them at all.
up drug prices in the long run by circumventing the negotiated drug lists, or so-called formularies, that are supposed to control medication costs and keep them fair for all consumers.
And keep in mind that HSAs are a good option only if you can afford to fund the accounts in the first place.
Employers could establish “out-of-pocket” maximums with the insurers they contract with, limiting how much employees pay per prescription or month. About a third of employers do this, according to the Pharmacy Benefit Management Institute.
The Trump administration has proposed similar limits for Medicare Part D plans.
Sens. Cory Booker, D-N.J., Bob Casey, D-Pa., and Bernie Sanders, I-Vt., have introduced legislation that would let consumers legally order drugs approved by the Food and Drug Administration from Canada.