U.S. seniors face tough choices over drugs
Medicare health plans force many retirees to cover staggering co-payment fees
For 23 years, Diane Whitcraft injected herself every other day with Betaseron, a drug that helps prevent flare-ups from multiple sclerosis. The drug worked well, drastically reducing Whitcraft’s trips to the hospital. But as her 65th birthday approached last September, she made a scary decision: to halt the medication altogether.
With health insurance through her job, Whitcraft had paid a $50 or $100 monthly co-pay for the drug; she didn’t realize the price of Betaseron had soared to more than $86,000 (U.S.) per year. Shopping around for drug coverage through Medicare, the out-of-pocket costs were mind-boggling: close to $7,000 annually.
“I was just feeling really bad that my disease was going to affect our retirement budget,” Whitcraft said. “You’re retired; you’re on a fixed income. And it just really was bothersome to me. I was doing this to us. This disease was doing this to us.”
Whitcraft’s dilemma highlights a growing problem with Medicare prescription drug coverage for seniors who take high-priced specialty drugs: There is no cap on how much they pay. Each prescription drug plan is structured a little differently, but people with very high drug costs almost inevitably enter what’s called the “catastrophic” phase of coverage. Then, they pay 5 per cent of the list price of their drug — no small sum in an age of $10,000-a-month cancer drugs or, in Whitcraft’s case, a more than $7,000-a-month multiple sclerosis therapy.
The number of seniors who reach the catastrophic phase has almost doubled over a four-year period, to more than 1 million people in 2015, according to a new analysis by the Kaiser Family Foundation. That trend was driven in part by a new generation of high-priced hepatitis C drugs, but includes high out-of-pocket costs for people taking drugs for cancer, multiple sclerosis, schizophrenia and HIV.
Whitcraft wrote a letter to the chief executive of Bayer, the company that makes Betaseron.
“It wasn’t filled with anger or anything; I just told him that I had quit the drug, and why. And I suggested someone must be very greedy,” she said. “It’s so wrong and so unfair — a drug that was marketed for the first time in 1993 . . . Why did the cost go up so much here?”
Whitcraft said she got a phone call from the company offering the drug at a discounted rate. She wonders, if it could offer her a discount on an individual basis, why they couldn’t just lower the price for everyone.