LETTER TO THE EDITOR: “Tiered” Drug Coverage by Health Insurers

There’s a new tool to limit the insurer’s pays for drugs patients need most.  It’s called “tiered” drug coverage.   Under a health care plan with “tiered” coverage, patients pay higher percents of the costs of drugs that patients need most and are most expensive.   Thus the policy of a patient with hepatitis C would require a higher percent co-pay of a hepatitis C drug than the percent the same patient would have to pay for generic thyroid or blood pressure drugs.   Even with recent negotiations where drug companies agreed to charge less than six figures for some new therapies and even though new protocols are presented as “cures,” patients’ costs could be more than most people earn annually.  Aren’t high prices for pharmaceuticals included in the increasing costs of health insurance over the past 30 or more years?

Such drastic increases in a patient’s co-pay will likely prevent some patients from treatments approved after taxpayer funded trials.  Some drugs could be denied to taxpayers that fund NIH drug trials. This impacts small group practices where the doctors have to pay for the drugs and be reimbursed by patients.  If small practices in towns close, people who can’t travel to major medical centers will be denied care.

Details appear in the January 29, 2015 issue of the New England Journal of Medicine.  Articles in the perspectives section of the journal are available to the public at no cost.  You can access the article via NEJM.org and go to volume 372, issue number 5 (there are two volumes each year and the journal isn’t 372 years old).  If you don’t want to click onto an address someone gives you, do a search for the New England Journal of Medicine to get to NEJM.org.

Marlene Salberg

Ann Arbor