Mental Health Costs to Drop After Override of Medicare Veto - Medicare patients' copays for psychiatric care will fall from 50% to 20% by 2014

There's some little-noticed good news for patients in the Medicare Improvements for Patients and Providers Act of 2008 that became law with Congress's override of President Bush's veto on Tuesday: Medicare beneficiaries in need of mental health services will soon face lower coinsurance payments and will have improved access to certain medications.

"We're going to save lives with this bill," says Nada Stotland, president of the American Psychiatric Association. The new law reduces the out-of-pocket cost for outpatient mental health services from the current 50 percent coinsurance payment to a 20 percent copay—matching the copay required for other types of medical care—by the year 2014. The reduction in beneficiaries' out-of-pocket costs will be phased in. Medicare recipients will continue to pay a 50 percent copay until 2010; in 2010 and 2011, they'll pay 45 percent; in 2012, 40 percent; in 2013, 35 percent; and in 2014, they'll have a 20 percent copay.

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When Drug Costs Soar Beyond Reach - Editorial

It doesn’t take a health policy expert to recognize that something has gone terribly wrong when patients have to pay thousands of dollars a month for drugs that they need to maintain their health — and possibly save their lives. Congress needs to determine why this is happening and what can be done about it.

The plight of patients who have recently been hit with a huge increase in their insurance co-payments for high-priced prescription drugs was laid out in The Times on Monday by Gina Kolata. Instead of paying a modest $10 to $30 co-payment, as is usually the case for cheaper drugs, patients who need especially costly medicines are being forced to pay 20 percent to 33 percent of the bill (up to an annual maximum) for drugs that can cost tens of thousands of dollars, or even hundreds of thousands of dollars, a year.

These drugs — what insurers call Tier 4 medicines — are used to treat such serious illnesses as multiple sclerosis, hemophilia, certain cancers and rheumatoid arthritis. And since there are usually no cheaper alternatives, patients must either pay or do without, unless they can get their medicines through some charitable plan.

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Co-Payments Go Way Up for Drugs With High Prices

Health insurance companies are rapidly adopting a new pricing system for very expensive drugs, asking patients to pay hundreds and even thousands of dollars for prescriptions for medications that may save their lives or slow the progress of serious diseases.
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With the new pricing system, insurers abandoned the traditional arrangement that has patients pay a fixed amount, like $10, $20 or $30 for a prescription, no matter what the drug’s actual cost. Instead, they are charging patients a percentage of the cost of certain high-priced drugs, usually 20 to 33 percent, which can amount to thousands of dollars a month.

The system means that the burden of expensive health care can now affect insured people, too.

No one knows how many patients are affected, but hundreds of drugs are priced this new way. They are used to treat diseases that may be fairly common, including multiple sclerosis, rheumatoid arthritis, hemophilia, hepatitis C and some cancers. There are no cheaper equivalents for these drugs, so patients are forced to pay the price or do without.

Insurers say the new system keeps everyone’s premiums down at a time when some of the most innovative and promising new treatments for conditions like cancer and rheumatoid arthritis and multiple sclerosis can cost $100,000 and more a year.

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