McGuffey: Patients need transparency, predictability in prescription drug plans

Author: Carleen McGuffey - February 14, 2017 - Updated: February 12, 2017

Carleen McGuffey
Carleen McGuffey

Nobody likes unpleasant surprises, particularly when it’s a bill for your out-of-pocket expenses on medicine that you need to stay healthy. These surprises are more and more common as insurance companies have increasingly shifted the cost of prescription medicine to consumers’ pocketbooks.

All across Colorado, one in four people are fighting chronic diseases. In my case, I was suffering with Hepatitis C for years until a new antiviral treatment came on the market, which turned out to be a life-saving medical miracle. I am one of the lucky ones. I am cured. For most with a chronic condition, a cure has yet to be developed for their disease, and their course of treatment could last a lifetime.

That could be a lifetime of surprise, out-of-pocket costs.

Patients are caught off guard, having to pay a growing share of prescription drug costs from their own resources — costs that our insurance carriers never informed us about.

In many cases, where there was once a fixed co-pay, insurers are now often requiring co-insurance which is a percentage of the drug’s cost, often as much as 50 percent, leaving consumers in the dark regarding their actual portion of the cost.

Coloradans across the state are joining the call for basic information regarding their health care. Recently, nearly 12,000 men and women with a chronic disease or their caregivers signed a Chronic Care Collaborative petition stating that they deserve to know what medications are covered by health insurance plans and how much their out-of-pocket costs are for those medicines before purchasing a plan. It is common sense.

This is a significant concern across our state. In a recent scientific poll conducted by the Partnership to Fight Chronic Disease, roughly 70 percent of Coloradans agreed that transparency is very important in knowing what medicines are covered by an insurance plan and the amount of related out-of-pocket costs.

There will always be a lot of variables in the health care equation. Health insurance plan designs change from one year to the next. The cost for the same drug and two different pharmacies, or two different counties, can have drastically different costs. But one thing should always remain constant: consumers’ right to information so they can budget and plan accordingly.

With unknown out-of-pocket costs, Coloradans living with chronic diseases, for whom staying on their medication is essential to their health, quality of life — and often survival — might be forced to reduce their dosage or come off their drugs altogether. Or they might go into debt or stop paying other bills. From a patient perspective, we need a solution to make insurance costs more predictable and transparent.

Instead of hitting patients with a front-loaded bill of thousands of dollars over a one or two month period — with nothing owed for the remaining months after their out-of-pocket maximum is reached — why not spread the cost over the full 12 months? This is not unlike the pro-consumer plans that energy companies use to level the high costs in expensive summer and winter months by creating a predictable uniform monthly cost. Colorado’s own Division of Insurance made a similar recommendation in a 2015 bulletin, but it is only a non-enforceable recommendation.

A number of states have found reasonable, common-sense solutions to help consumers navigate health insurance, and create a more stable and predictable structure for out-of-pocket costs. For example, in California, Delaware, Maryland and Louisiana, policymakers have enacted changes to restrict the maximum amount a consumer would have to may per month for prescription drugs.

As someone who suffered through not only a debilitating and life-threatening disease, but also the struggles of fighting our insurance company for basic information related the medicine that has given me a new lease on life, I am a strong supporter of transparency and predictability in the health insurance plans that give us access to the prescription drugs we desperately need.

Carleen McGuffey

Carleen McGuffey is the founder of Climbing for Carleen, a non-profit organization created to raise awareness and education on liver disease and hepatitis C, promote testing and organ donation and make medicine available for the cure to everyone who needs it. For more information, visit www.climbingforcarleen.com

One comment

  • Virginia Gebhart

    February 16, 2017 at 4:41 pm

    Thank you Carleen for speaking up on this issue. It gets harder and harder every year for my son, a liver transplant recipient, to get his prescriptions filled and covered by his insurance. We consumers are powerless to push back against this continual cost shifting for prescriptions so that we pay more and more every year, while insurance company executives take home millions and millions of dollars every year.


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