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Consumers Paying More For Prescription Drugs As More Insurers Drop Copays

SAN FRANCISCO (KPIX 5) – The price of prescription drugs has been skyrocketing, but until now most people haven't noticed because they were only responsible for the copay. Consumers could soon pay the difference, as copays become a thing of the past.

Most major insurers are quietly changing their prescriptions drug plans, forcing consumer to pay a hefty percentage of the total drug costs instead of a pre-determined fee.

The label warns he shouldn't skip a day, but like many Kerry Egdell may soon not have a choice as most insurance companies are changing the way they pay for your prescriptions.

"My copays have gone up from $45 or $226 and some change because they moved the medication from tier 3 to tier 5," Kerry Edgell told KPIX 5 ConsumerWatch.

Until recently, insurers generally had one set co pay for generic drugs, and another for brand name drugs like Kerry's. But last year, most added yet another tier or category called "specialty drugs."

And along with the new category, comes a new cost to consumers. Instead of paying a copay, insurers are now charging a percentage of the total cost of specialty drugs.

"That's five times the original cost," Edgell said.

And some insurers are now moving even seemingly common brand name drugs to the new specialty category, like Edgell's antidepressant.

Insurers point to the skyrocketing price of specialty drugs as the catalyst for the move, arguing if they don't pass the cost on to the enrollees who use them, they would have to raise premiums and copays for everyone.

But many believe that will happen anyway.

"It's something that effects everyone, whether you take the drug personally or not," healthcare advocate John Roth said. Roth points to the increasing cost of specialty drugs like Sovaldi, a $1,000 per pill medication used to treat hepatitis C.

He blames drug companies for charging exorbitant fees, but the drug companies counter they're simply recouping their research and development costs.

"The United States is unique in that we don't bargain with the drug manufacturers to get a more reasonable cost. And just about every other country does," Roth said.

Policymakers across the country said they working to address the high price of prescription drugs, but in the meantime, that's no consolation for those who need their medication now.

"You expect costs to go up, but not five times," Edgell said.

Most insurers have financial assistance programs for low-income enrollees. And many drug companies have programs that will supplement the cost of your name brand prescription, but Edgell didn't qualify because he's on Medicare.

At least for Edgell, a generic form of his prescription is expected on the market soon, likely the reason the cost of his prescription skyrocketed, and the reason his insurer re-classified it as specialty.


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