Many Insurers Changing Prescription Categories So Customers Pay More For Already Expensive Meds

Patients across the country who rely on drugs that are already expensive to treat complicated conditions like cancer and rheumatoid arthritis are in for an unwelcome uptick in costs for those meds, as many insurers are changing things up in order to charge customers more.

The Los Angeles Times says insurers like Anthem Blue Cross, Aetna and others are moving many prescriptions to a new category, which will require patients to absorb more of the cost of the drugs.

That means pharmacy bills rising by hundreds of dollars per month, on top of already pricey insurance premiums. For example: One man who was previously paying $80 for three HIV drugs is now paying $450 per month on a new plan from Anthem Blue Cross.

Says the L.A. Times:

Anthem, the state’s largest for-profit insurer and a unit of WellPoint Inc., adjusted its prescription drug coverage early this year. It said it shifted more medications to the most expensive tier for many of its employer plans to keep premiums more affordable.

“Because high-cost pharmaceuticals reduce the affordability of health insurance, Anthem moved some of these drugs from a co-pay tier to a cost-sharing tier,” said company spokesman Darrel Ng. “We continue to evaluate and refine the drug classifications in our four-tier plans to enhance value and affordability.”

Aetna says the company is responding to the concerns of employers who are seeing specialty drug costs rise, so they’re adding new drugs to the highest cost tiers.

Some consumer advocates worry that this will cause workers to stop taking the medications they need, which could result in costly medical care in the future. About 20 states have proposed legislation to cap out-of-the-pocket expenses for prescriptions, but of course, the insurance industry doesn’t want that to happen. Insurers claim those caps would drive up premiums across the board for all customers.

“Capping out-of-pocket costs doesn’t make healthcare less expensive. It just shifts costs into premiums,” said Charles Bacchi, executive vice president of the California Assn. of Health Plans, an industry group fighting such legislation.

Insurers forcing patients to pay more for costly specialty drugs [Los Angeles Times]