Drug copays sometimes exceed costs

From Reuters:

Insurance companies may be asking people to shell out more money for drug co-payments than the drugs actually cost, a new study suggests.

Generic drug co-payments in the U.S. exceeded the cost of medicines about 28 percent of the time – or for more than one in four prescriptions, researchers found.

Co-payments for branded drugs were higher than the medication cost about 6 percent of the time, they report in JAMA.

McCaskill Calls for Review of Anthem’s Emergency Room Policies

Press Release:

U.S. Senator Claire McCaskill is calling for a full review of the actions by health insurer Anthem to deny emergency room coverage for Missourians’ care that is deemed non-emergent—a potential violation of consumers’ rights and federal law.

“[W]e remain concerned that Anthem’s [emergency department] policy still forces patients to determine, before they even leave their home, if their symptoms are serious enough to go to the emergency room,” wrote McCaskill and Senator Ben Cardin of Maryland to the Secretaries of Health and Human Services, and Labor. “The Prudent Layperson Standard was specifically drafted to allow patients to get the services they need, when they need them. Patients should not be forced to act as their own doctors and second guess themselves when they truly believe that they are having a medical emergency. Anthem’s coverage denials are creating obstacles to emergency room care and are leaving patients responsible for thousands of dollars in medical bills.”

McCaskill’s letter outlines Anthem’s potential violation of federal law by disapproving emergency room claims that may be required to be allowed under the Prudent Layperson Standard, a law that requires emergency room coverage where absence of immediate medical attention would place the health of the individual in serious jeopardy.

McCaskill has made tacking rising healthcare and prescription drug costs in Missouri a top priority in the Senate. She is demanding answers from Anthem after the insurance company announced it would no longer cover emergency room costs for Missourians if the care is deemed non-emergent. And last month, healthcare and emergency room costs in Missouri and across the country were the focus of a roundtable discussion with McCaskill, ER doctors, patient advocates, and community health workers in Kansas City.

Last year, McCaskill, the top-ranking Democrat on the Homeland Security and Governmental Affairs Committee, sought answers from Envision Healthcare and its subsidiary EmCare Holdings, Inc. following reports of skyrocketing costs at emergency rooms run by EmCare. According to those reports, EmCare tripled the highest rate for ER visits at one hospital that was studied and allegedly pressured ER doctors to order expensive, unnecessary tests for patients. EmCare manages more than ten hospitals in Missouri.

Some Anthem patients afraid to use ED under new policy

From Becker’s:

Ohio residents with Anthem insurance told The Plain Dealer they fear Anthem’s discretionary emergency department policy will negatively affect them.Anthem rolled out its controversial ED policy in Ohio Jan. 1. Under the coverage change, the insurer reviews diagnoses after members’ ED visits. If their condition is determined to be nonemergent, Anthem may not cover their ED claims, with several exceptions.

The Plain Dealer asked readers Feb. 22 to submit their experiences under the new policy. “Readers say they are afraid to visit the emergency room and potentially be saddled with expensive medical bills,” the newspaper found.

One reader who is covered through his wife’s Anthem policy, Matt Vale, told The Plain Dealer, “I wonder every day if me or my wife have a trip to the ER, will it be covered?”