Monday, April 21, 2008

considering options - and tiers

This article, "Co-Payments Go Way Up for Drugs With High Prices" turned up in my inbox, and scared the bejaysus out of me.

Not to mention freaking out any number of people with hemophilia, parents of people with hemophilia - and I'm sure the folks with von Willebrands weren't singing O Happy Day, neither. Nor the folks with MS, funky cancers, or anything else potentially treated with a tier 4 or tier 5 class drug.

I sent a worried email off to the National Hemophilia Foundation, who said...nothing. I sent a worried email off to my local NHF chapter, who told me (within the hour) that not only were they working on it, they were more immediately worried by Blue Cross-Anthem's single pharmacy plan, which is inexorably working it's way across the country. I agreed. I was worried, too.

Oh, the details of this plan are simple: Blue Cross/Anthem/Wellpoint makes an exclusive deal with a pharmacy whom they own, that all of their bleeding disorder folks will use this pharmacy. Want home care nurses? you only get it if the pharma folks offer it. They don't? Too bad, use the ER, even if it's just the get the kid looked over, or a follow-up infusion. Want to preserve your lifetime cap? Well, so much for shopping around to get the lowest drug prices - you get one home care, and whatever they charge, they charge. Consider this: higher drug prices, the higher costs of ER care vs home nursing care - all of this fills up the lifetime cap and gets the person with bleeding disorders off the books faster. And no, I wish I were paranoid.

Thinking about the NYTimes article (and saddened and intrigued by some of the blogospheric responses), I went to fill a prescription at our local pharmacist. Now, we use a local independant (family-run) pharmacy for most of our 'scripts, and I know they are a luxury - our pharmacy plan makes us pay a couple of bucks extra per prescription to use them, as opposed to mail-order. But once, when the Eldest was diagnosed with two different class of antibiotic allergies, these pharmacists printed out a list of drugs from those classes and handed them to the Man. And we happened to recognize a drug off the list that an intern tried to prescribe for the Eldest, not two weeks later. And prevented a rather horrific repeat of an initially horrific reaction. (Allergen pushed directly into the heart = bad, bad news.) Since then, they've made a special point of looking out for us, helping us find corn-free medications for the Toddles, help with horrific eczema for the Eldest. Oh, yes, they are a luxury. But we don't get this kind of help at CVS.

When I paid for my prescription, I mentioned the NYTimes article to the pharmacist. Oh, yes, he said, that's been written up in pharmacy journals for ages. The insurance company's been paving the way for this for a long time, starting by getting folks used to the idea of tier 1 and tier 2 drugs, and then moving on to a tier 3...and now this. It's been coming for a long time, he said. It means that now, instead of everyone paying and spreading the costs around, now it'll cost you more to be sick. I raised an eyebrow. Yep, he said, next is buying a special tier 4 or tier 5 drug coverage - assuming you can afford it. I thought about this. According to many blog commentators, me being able to afford it is just a matter of me giving up a latte at Starbucks, or eating beans and rice a couple of times a week. But we already do that. So now what?

I walked out, thoughtful and worried. Insurance is failing. If the patience inherent in the tiered drug plan is any guide, health insurance has been failing for some time. So, now what happens? Because a 20-33% copay on the Eldest's hemophilia meds will bankrupt us, and quickly. And is this really what the government wants to see happen to nice, middle class folks who work hard? Or maybe the point is, is the government willing to do something to protect us? Somehow, a scared, cynical voice says, I don't think so.

Still, says a hopeful and equally scared voice, it's Passover. Could this, too, be a plague that terrifies and yet passes us by? Somehow, I suspect it will - but only if there's some sensible and vocal protest from the Israelites involved. I'll be calling the local chapter's advocacy group and volunteering to go and talk to legislators. Hopefully, someone will listen.

There's blood on my doorposts, people, and it don't clot. So don't y'all go buggin' us!
One of the side effects of reconstructing my pantry for Pesach is that I buy a lot of groceries. Which means that for once, I actually don't have enough reuseable bags. (Note: eco-whatever you like, but reuseable bags means no plastic inhaled-choking hazard shopping bags. Also, reuseable bags hold more groceries per bag, and when you are trying to get seven shopping bags plus two kids (read: five kid-shaped objects. somehow.) up the stairs into your apartment, trading seven lighter bags for three heavier bags is just fine by me. So.)

So, plastic shopping bags accumulate in our apartment, and now what? Well, we reuse them slowly, as car garbage bags, unexpected poopy diaper bags, wet togs bags, etc - but then there's this rather kickass option. A hat tip to Girl Bleeder for this one!

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