Tough choices regarding costly RA drugs | Arthritis Information

You’re probably getting "sticker shock" these days every time you go to the grocery store or fill up your gas tank.

But that’s nothing compared to what some customers are experiencing at the pharmacy. Because many insurance plans have changed their pricing policies, some patients are being charged hundreds of dollars for their medicine even though they have prescription drug coverage.

"It kind of defeats the purpose of having insurance, doesn’t it?" said Laird Miller, owner of Medical Park Pharmacy in Gainesville.

Over the past year, a growing number of insurance plans have quietly switched to a new pricing system, often without informing patients. In the past, most plans charged a co-pay, such as per prescription for a generic drug and for a brand name.

But now, patients may be charged a percentage of the total cost of a brand-name drug, typically about one-third. This is especially true for so-called Tier 4 drugs, which tend to be very expensive.

Such pricing is supposed to motivate patients to switch to cheaper generics. But most Tier 4 drugs are for serious illnesses with limited treatment options, and no generic is available.

"You see this with other chronic diseases such as lupus, Crohn’s disease and rheumatoid arthritis," said Debbie Means, case manager at the Multiple Sclerosis Center of Atlanta.