The system, often called Tier 4, began in earnest with Medicare drug plans and spread rapidly. It is now incorporated into 86 percent of those plans. Some have even higher co-payments for certain drugs, a Tier 5.
Now Tier 4 is also showing up in insurance that people buy on their own or acquire through employers, said Dan Mendelson of Avalere Health, a research organization in Washington. It is the fastest-growing segment in private insurance, Mr. Mendelson said. Five years ago it was virtually nonexistent in private plans, he said. Now 10 percent of them have Tier 4 drug categories.
By way of an example, a woman insured by Kaiser Permanente who had been paying $20 per month for Copaxone, was asked to pay $325. Kaiser's suspended the increased copay for now, but next year she'll need to change plans or pay up. Raising copays for a few sick people means many healthier people will pay less (duh), but, as a practical matter, also means the health insurance safety net is getting smaller.
Between Rebif and the various other drugs I take for the symptoms of MS, I pay about $120 a month in copays. That's pretty easy to manage-- it's money we might otherwise use to go out to dinner or to save for a vacation, but it's not a big sacrifice. But if that went up to $500 per month, we'd be in some trouble. My wife probably wouldn't be able to go back to school for a nursing degree. We probably wouldn't be saving as much for retirement. If it went up to $1,000 per month, we'd be in serious trouble. I'd start thinking about which meds I could live without. We'd probably think about selling the house and moving somewhere substantially cheaper.
On one hand, this makes me nuts: the only way I can afford the care I need is if healthy people subsidize it, and it seems perfectly rational for you healthy people to want not to subsidize my care. On the other hand, I'm reasonably confident that I'd probably be just fine, because the quality of my life and everybody else's doesn't have much to do with how much money or stuff we have, as long as we can take care of the basics. Which, of course, is exactly what a sick person is supposed to say, because it's one of the best arguments I can think of to explain why Joe Healthypants down the hall should pay in insurance premiums twice what he actually uses in services, instead of buying himself a new snowblower.
Link to NYT.