A few weeks back we wrote about drug affordability problems related to high deductible Obamacare silver plans. A new report finds problems across all four tiers for patients requiring expensive specialty drugs. Many plans have co-insurance rather than a fixed co-pay for these medications, which means patients pay a percentage of a drug’s price rather than a flat fee. In fact, over 50% of bronze, silver, and gold plans studied had co-insurance rather than fixed co-pays for specialty drugs. That compares to only 38% for platinum plans.
According to Wellmark, “Specialty drugs are prescription medications that require special handling, administration or monitoring. These drugs are used to treat complex, chronic and often costly conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C, and hemophilia.”
Pamela Morris, of Zitter Health Insights, said “A lot of times, if someone has coinsurance their first exposure to OOP [out of pocket costs] is at the pharmacy, where they may be unsure if they’ve met their deductible or if the costs are purely coinsurance.”
So how big could this price shock be? Let’s look at Tecfidera, a sample oral Multiple Sclerosis drug. The cash price is around $6,000 for 60 capsules of the 120 mg dose. Even if your co-insurance is 25%, that’s $1,500. You can purchase the same amount for $1,200 from an international online pharmacy. Still expensive, but a $300 savings is nothing to scoff at. And it’s likely that the co-pay would be even more than 25% in which case the international savings could be much higher.
Gleevec, a medication used to treat certain types of leukemia, is around $29,000 for 90 pills. That will cost you $7,500 if your co-insurance is only 25%. Using an international online pharmacy, you can purchase 90 pills of generic Gleevec for $725 from a Canadian pharmacy. This may even be cheaper than using Novartis’s patient assistance program for brand name Gleevec. The program has strict eligibility requirements but is worth pursuing if you believe you’re eligible.
We’re sorry to report that many specialty meds may not be safe to order from an international online pharmacy. Some might be extremely temperature sensitive, others are administered in a clinical setting, only sold by specialty pharmacies, and some aren’t even approved for sale outside the U.S. For some specialty drugs, the savings might not even be that great, as prices are high globally!
We promise to research all avenues of savings for these medications and report back to you soon…