New generation of MS drugs becoming unaffordable

From The Seattle Times August 17:

Sally Garcia, (pictured left) a 53-year-old lawyer disabled by multiple sclerosis, was torn.

A new-generation medication, Copaxone, was really working for her. After two decades of being in and out of hospitals, Garcia was taking steps to work again.

Her wallet, though, was in severe distress. Under her Medicare prescription plan, Garcia's share of the expensive drug was $330 per month. All together, medications were taking a third of her disability payments — her only income — and she couldn't swing it.

Copaxone, Enbrel, Remicade: For some patients, such new-generation drugs, often called "biologicals" or "bioengineered" when they are created by genetically modified living cells, have performed magic. In some cases, they work when other drugs have failed, or for diseases that previously had no drug treatments at all.

But they cost a lot — often $2,000 to $3,000 per month.

And in a double whammy, some insured patients who previously paid a fixed amount — likely $30 to $50 even for the most expensive, brand-name drugs — are suddenly finding the rules have changed.

For these new drugs, an increasing number of patients must pay a percentage of the tab, generally 25 to 30 percent. For many of those patients, that can mean a bill of $600 to $900 a month for a drug that they may need for many years.

The rising bill for such complex drugs threatens to financially overwhelm patients and employers, and — if current trends continue — to unravel the very philosophy of health insurance.

"The idea of insurance is to protect people from catastrophic costs," says Gary Claxton, director of the Healthcare Marketplace Project for the Kaiser Family Foundation.

"At some point, people aren't going to consider themselves insured if they're at risk for a huge amount out-of-pocket just because they have one disease rather than another."