NEWS - Patients suffer as a result of insurance pricing scheme

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American College of Rheumatology

20 Mar 2009

PATIENTS SUFFER AS A RESULT OF INSURANCE PRICING SCHEME

Mississippi Fights Back; Could Lead Nation in Efforts to Overturn Tier

IV Pricing

ATLANTA – Millions of patients suffering from diseases such as

rheumatoid arthritis, multiple sclerosis, hemophilia, hepatitis C and

certain types of cancer are at risk of incurring thousands of dollars

in medical expenses due to a new pricing system being implemented by

many insurance companies across the United States.

Health insurance companies are rapidly adopting this new system,

commonly called Tier IV, for many of the expensive drugs used in the

treatment of several diseases – asking patients to pay hundreds and

even thousands of dollars a month for needed prescriptions. Blue Cross

Blue Shield of Mississippi was one of many insurance companies to

adopt this system, forcing its policyholders to shoulder 20 to 40

percent of the costs of their medication.

Traditionally, individuals and families pay reasonable co-pays for

medications as part of their health insurance coverage, such as $15

for generic, $20 for brand name, or $30 for off formulary. Tier IV

pricing goes above-and-beyond the traditional co-pay, forcing patients

to pay hundreds or thousands of dollars out-of-pocket each month. For

many rheumatology patients affected by Tier IV pricing, these costs

are staggering, and because Tier IV often applies to the most

expensive medications (such as infusions) these patients often

consider other options, including stopping treatment.

" The Tier IV pricing system essentially represents discriminatory

pricing for certain patients,” explains King, MD, a

rheumatologist in Tupelo, Miss. “Asking my patients to pay 20 to 40

percent of their drug costs out-of-pocket (often up to $600 each

month) means they will not have access to these life-altering

therapies. My office has been flooded with calls from worried patients

since the Tier IV system took effect. They are fearful of losing

access to medicines that afford them the ability to lead independent,

productive lives, and this is of great concern to me as their

rheumatologist.”

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Read the full article here:

http://www.rheumatology.org/press/2009/2009_03_20.asp

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