Protect patients from the influence of copays – Opinion Piece
As a blood cancer doctor, my job is to diagnose my patients’ conditions and determine the best treatment plan. But medical school never prepared me for what I am now faced with: prescribing subpar treatments because of costs.
In my 15 years in medicine, cancer care has advanced so dramatically that diagnoses once considered a death sentence can now, in some cases, be treated with a daily pill. But health insurance programs haven’t kept up with the science. Exorbitant out-of-pocket costs, particularly for Medicare patients, keep many of these treatments out of reach. My experience with a recent patient is typical. Soon after diagnosing her with a type of lymphoma, I intended to prescribe a treatment – a simple pill. This treatment is considered a standard of care, not “off-label”. Our staff soon learned her copay for the drug would be more than $10,000 annually. To be clear, this isn’t money she would owe me or my clinic; it’s what she would pay the pharmacy to fill her prescription.
My patient would not be able to afford that treatment; even paying for transportation to our clinic was a struggle for her. While our team works to connect patients with programs that help with copays, support wouldn’t be available for her quickly enough and long enough. That left me with an excruciating choice: Should I let her know the best treatment for her cancer is one she can’t afford? Or do I offer her a treatment that’s less effective but financially within reach? I had to choose the latter.
Situations like these are increasingly common because of the way Medicare covers prescription drugs like the pills I initially planned for her. Through the Medicare Part D program, patients filling costly prescriptions can owe thousands of dollars in upfront costs, followed by a 5% copay for the rest of the year.
That 5% may seem small, but with list prices often in the six figures, it can still result in a massive bill. Some of my Medicare patients are paying $10,000 or more annually out-of-pocket for their treatment – and they’ll pay that as long as they live. That’s a huge sum for anyone, particularly retirees living on fixed incomes.
But it doesn’t have to be this way. Federal lawmakers are considering a proposal to cap Medicare patients’ out-of-pocket prescription costs at $2,000 annually. If done right, the plan could also put an end to huge single-month costs by allowing every patient to spread those costs over the year to make them more manageable. Various versions of this plan have won bipartisan support.
Situations like the one facing my patient prove the status quo isn’t working. And the problem is getting worse with each year. The stakes are extremely high: When patients are required to pay $2,000 or more out-of-pocket for their cancer care, they’re five times more likely to simply abandon their treatment. That’s why I urge Sens. Michael Bennet and John Hickenlooper, and the rest of Congress, to finally fix Medicare Part D this year. For many Coloradans I see, their lives depend on it.
Source: Michael Tees – Colorado Blood Cancer Institute, Denver
Michael Tees has been a physician at the Colorado Blood Cancer Institute in Denver since 2015 and serves on the board of directors of the Rocky Mountain Chapter of The Leukemia and Lymphoma Society