![]() ![]() Often, insurers require patients to pay 50% of the cost of specialty drugs. One of the tools insurers use to discourage patients from obtaining expensive medication is placing those prescriptions in what’s called a higher drug “tier.” This means the insurance company expects the patient to pick up a bigger percentage of the cost, so the patient’s copay is higher for that medication. Once an insurance company does finally approve a new drug, the copay - the amount patients have to pay beyond what an insurer covers - can come as a shock to patients. So they require patients to go through steps to prove they’ll benefit before the health insurance companies cover the medications.ĭoctors must submit documents to prove that cheaper therapies have failed, they sometimes have to order genetic testing, and they must apply for pre-authorization from insurance - all before patients get their first pill. Naturally, insurance companies only want to pay for these expensive treatments when medically necessary. No one can afford that.” Insurance already limits use of brand-name prescription drugs So there are some drugs that are over a million dollars a year,” McGarry said. “Pharmaceutical companies have found out that they can charge ridiculous amounts of money for drugs. Such prices are becoming more common as new treatments come onto the market for cancer, autoimmune disorders and other diseases. This provided photo shows the medicine Trikafta, which is used to treat the underlying cause of cystic fibrosis. A new cystic fibrosis medication, brand name Trikafta, costs more than $300,000 per year for each patient. “It’s been amazing.”īut these breakthrough medications don’t come cheap. “Instead of patients dying from their lung disease or needing a lung transplant, their lungs really improve and they go back to living a normal life, graduating from high school, getting a job, getting pregnant,” McGarry said. “It has really transformed the whole disease,” she said.Īverage lifespans for people with cystic fibrosis have nearly doubled. Meghan McGarry, a pediatric pulmonary doctor and professor at the University of California, San Francisco, has watched a lot of changes in the world of cystic fibrosis over the last decade, thanks to a new class of drugs that target the condition’s underlying cause. It all comes back to rising drug pricesĭr. Last week, legislators chose not to attach this amendment to a drug pricing bill, hampered in part by the Republican-led walkout in the Oregon Senate. Oregon legislators have failed to pass this legislation three times in the past three years. The Oregon Legislature was the latest body to consider changes to these policies, which can cost patients tens of thousands of extra dollars per year, but patients will have to wait for a fix. Now, they’re being used more often and can result in patients paying many thousands of dollars more than they might have expected. These are programs in insurance plans initially designed to keep patients from choosing expensive medications when a generic alternative is available. ![]()
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