Consumers hit harder by medicine copayments
A majority of consumers said the biggest change in their health insurance last year was higher copayments for prescription drugs, according to survey results released yesterday.
The results are another indication that patients are bearing an increasing burden of healthcare costs.
The informal survey of 915 visitors to the website of Weiss Ratings Inc., a financial risk analysis firm in Jupiter, Fla., found that 34.3 percent said the higher drug copayments they must pay reflect the biggest change, while 23.8 percent said the copayment for a visit to the doctor was biggest.
''Absent any real reform in truly managing care, it's going to cost more -- and that is being passed along to individuals," said Melissa Gannon, a vice president at Weiss Ratings, which specializes in health and other forms of insurance.
The findings echoed a major, more scientifically rigorous survey of employers last year by the Kaiser Family Foundation, a nonprofit research organization in Washington, that showed sharp increases in prescription copays over the past five years. That poll broke down patients' share of costs within so-called tiered copayment arrangements, which have become ubiquitous in prescription drug coverage.
In tier 1, which includes the cheapest generic drugs, average copayments rose to $10 in 2004 from $7 in 2000. In tier 2, for brand-name drugs the insurer has designated as the ''preferred" choice, average copayments rose to $21 from $13 in 2000. And for the brand-name drugs designated by the insurance company as ''nonpreferred" and placed in tier 3, the average copayment nearly doubled, to $33 from $17.
The result is rising sticker shock for people on maintenance medications, particularly the elderly.
''If your copay went up from $10 to $20, and you're taking four or five drugs a month, that can be a big burden," said David Gross, a senior policy adviser in Washington for AARP, the nonprofit group that represents Americans over 50.
Cindy Parks Thomas, senior research scientist at the Schneider Institute for Health Policy at Brandeis University, said incremental changes in drug copayments add up faster than other cost-shifting strategies like higher payments for doctor's office visits and hospitalizations.
''People go to the pharmacy every month -- especially senior citizens. They are going to notice even a little change," she said.
In an editorial in the New England Journal of Medicine in December 2003, Thomas reported on the explosion in tiered copayment systems for prescription drug coverage. A decade ago, the average copayment for all prescriptions was $5.
Today's copayments, she said, averaging as much as seven times more for the most expensive brand names, are derived through contract negotiations between drug companies, insurers, and employers. The details of those contracts are not disclosed to the public, she said.
Thomas also said some people aren't taking their drugs because of the higher out-of-pocket expense. While consumers are given an incentive to choose lower-cost generics, the tiered setups give them an incentive to take less medicine. ''With the higher cost-sharing, some people are going without their drugs," she said.
The insurance industry and employers say rising copayments reflect an effort to strike a balance between access to healthcare and affordability.
Tiered plans with their higher prices for certain drugs provide patients with , additional choices that might not be available under more restrictive plans with a single copayment, said Mohit Ghose, spokesman for America's Health Insurance Plans, the industry's Washington lobbying organization. A crucial next step, he said, is improving the spread of information about head-to-head comparisons of drugs within an individual class, so patients and their doctors will know when it is appropriate to switch to the lower-cost generics.
Christopher Rowland can be reached at crowland@globe.com.
