WASHINGTON – Cancer patients could face high costs for medications under President Obama’s health care law, industry analysts and advocates warn.
Where you live could make a huge difference in what you’ll pay.
To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.
Such specialty drugs can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month’s supply, health advocates said.
New York is taking a different approach, setting flat dollar co-payments for medications. The highest is $70, and it would apply to specialty drugs as well.
Critics fear most states will follow California’s lead, defeating the purpose of the overhaul as some of the sickest patients may be unable to afford their meds.
It’s important that the benefit design not discriminate against people with chronic illness, and high copays do that, said Dan Mendelson, president of Avalere Health, a data analysis firm.
Avalere’s research shows that 1 in 4 cancer patients walks away from the pharmacy counter empty-handed when facing a copay of $500 or more for a newly prescribed drug.
You have to worry about a world where if you happen to contract cancer or multiple sclerosis, you are stuck with a really big bill, Mendelson said. It’s going to be very important for states to take a long, hard look at their benefit design.
Although the money for covering uninsured Americans is coming from Washington, the heath care law gives states broad leeway to tailor benefits, and the local approach can also allow disparities to emerge.
Insurers are forecasting double-digit premium increases for individual policies, as people with health problems flock to buy coverage previously denied them.
The Obama administration insists the industry warnings are overblown, and that for many consumers, premium increases will be offset by tax credits to help buy insurance.
And officials say it’s important to realize the law sets overall limits on patients’ liability, even if those seem high to some people.
A full picture of costs and benefits isn’t likely to come into focus until the fall.