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HUGE DRUG COST DISPARITIES SEEN IN HEALTH OVERHAUL
Monday, 13 May 2013 11:14 Published in Health & Fitness
WASHINGTON (AP) -- Cancer patients could face high costs for medications under President Barack Obama's health care law, industry analysts and advocates warn.
Where you live could make a huge difference in what you'll pay.
To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.
Such "specialty drugs" can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month's supply, says the Leukemia & Lymphoma Society.
New York is taking a different approach, setting flat dollar copayments for medications. The highest is $70, and it would apply to specialty drugs as well.
Critics fear most states will follow California's lead, and that could defeat the purpose of Obama's overhaul, because some of the sickest patients may be unable to afford their prescriptions.
"It's important that the benefit design not discriminate against people with chronic illness, and high copays do that," said Dan Mendelson, president of Avalere Health, a data analysis firm catering to the health care industry and government.
Avalere's research shows that 1 in 4 cancer patients walks away from the pharmacy counter empty-handed when facing a copay of $500 or more for a newly prescribed drug.
"You have to worry about a world where if you happen to contract cancer or multiple sclerosis, you are stuck with a really big bill," Mendelson said. "It's going to be very important for states to take a long, hard look at their benefit design."
Although the money for covering uninsured Americans is coming from Washington, the heath care law gives states broad leeway to tailor benefits, and the local approach can also allow disparities to emerge.
A spokesman for Covered California said state officials are trying to balance between two conflicting priorities: comprehensive coverage and affordable premiums.
"We are trying to keep the insurance affordable across the board," said Dana Howard, the group's spokesman. "This is just part of trying to manage the overall risk of the pool." Covered California is one of the new state marketplaces where people who don't get coverage on the job will be able to shop for private insurance starting this fall. Coverage takes effect Jan. 1.
Insurers are forecasting double-digit premium increases for individual policies, as people with health problems flock to buy coverage previously denied them. The Obama administration says the industry warnings are overblown, and that for many consumers, premium increases will be offset by tax credits to help buy insurance. And officials say it's important to realize that the law sets overall limits on patients' liability, even if those seem high to some people. Still, a full picture of costs and benefits isn't likely to come into focus until the fall.
Howard said California officials are aware of the concerns about drug costs and are trying to make medications more affordable.
Meanwhile, he said consumers will be protected because the law limits total out-of-pocket costs - the deductibles and copayments that policy holders are responsible for, apart from monthly premiums. In California, the annual out-of-pocket limit for an individual is $6,400, although it can be as low as $2,250 for low-income people. Once that limit is reached, insurance pays 100 percent.
That's still a lot of money, and such reassurances haven't dispelled the concerns.
"The intent of the Affordable Care Act is to make sure that all Americans have access to quality, affordable health care," said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. He adds that there is a danger that the insurance marketplaces "will discriminate against the patients with the highest medical need. That would completely undermine the spirit of the ACA."
The group has been joined by Rep. Doris Matsui, D-Calif., in urging state officials to reconsider the policy. The high copays "could prevent many patients from receiving the lifesaving treatments they need because of prohibitively high cost," Matsui wrote to the state.
The problem with costly drugs is similar to another money issue with the health care law - a provision that could price millions of smokers out of coverage. Insurers are allowed to charge tobacco users buying an individual policy up to 50 percent higher premiums. For a 55-year-old smoker, the penalty could reach nearly $4,250 a year, on top of the standard premium. California is trying to override that problem by passing its own law. There's also pending state legislation to address some issues with prescription costs, but its prospects are unclear.
Meanwhile, leukemia patient Lisa Lusk worries about what will happen to her. A nursing assistant who lives near Fresno, Lusk is hoping to return to work in the next few months. When that happens, she expects to lose emergency coverage she's now getting through the state. And the medication Lusk takes to manage her chronic form of the disease costs more than $5,000 a month.
"I'm scared that when I get a job my copay may be more than $1,500 a month," said Lusk. "I'll just be working to pay for my medications."
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Where you live could make a huge difference in what you'll pay.
To try to keep premiums low, some states are allowing insurers to charge patients a hefty share of the cost for expensive medications used to treat cancer, multiple sclerosis, rheumatoid arthritis and other life-altering chronic diseases.
Such "specialty drugs" can cost thousands of dollars a month, and in California, patients would pay up to 30 percent of the cost. For one widely used cancer drug, Gleevec, the patient could pay more than $2,000 for a month's supply, says the Leukemia & Lymphoma Society.
New York is taking a different approach, setting flat dollar copayments for medications. The highest is $70, and it would apply to specialty drugs as well.
Critics fear most states will follow California's lead, and that could defeat the purpose of Obama's overhaul, because some of the sickest patients may be unable to afford their prescriptions.
"It's important that the benefit design not discriminate against people with chronic illness, and high copays do that," said Dan Mendelson, president of Avalere Health, a data analysis firm catering to the health care industry and government.
Avalere's research shows that 1 in 4 cancer patients walks away from the pharmacy counter empty-handed when facing a copay of $500 or more for a newly prescribed drug.
"You have to worry about a world where if you happen to contract cancer or multiple sclerosis, you are stuck with a really big bill," Mendelson said. "It's going to be very important for states to take a long, hard look at their benefit design."
Although the money for covering uninsured Americans is coming from Washington, the heath care law gives states broad leeway to tailor benefits, and the local approach can also allow disparities to emerge.
A spokesman for Covered California said state officials are trying to balance between two conflicting priorities: comprehensive coverage and affordable premiums.
"We are trying to keep the insurance affordable across the board," said Dana Howard, the group's spokesman. "This is just part of trying to manage the overall risk of the pool." Covered California is one of the new state marketplaces where people who don't get coverage on the job will be able to shop for private insurance starting this fall. Coverage takes effect Jan. 1.
Insurers are forecasting double-digit premium increases for individual policies, as people with health problems flock to buy coverage previously denied them. The Obama administration says the industry warnings are overblown, and that for many consumers, premium increases will be offset by tax credits to help buy insurance. And officials say it's important to realize that the law sets overall limits on patients' liability, even if those seem high to some people. Still, a full picture of costs and benefits isn't likely to come into focus until the fall.
Howard said California officials are aware of the concerns about drug costs and are trying to make medications more affordable.
Meanwhile, he said consumers will be protected because the law limits total out-of-pocket costs - the deductibles and copayments that policy holders are responsible for, apart from monthly premiums. In California, the annual out-of-pocket limit for an individual is $6,400, although it can be as low as $2,250 for low-income people. Once that limit is reached, insurance pays 100 percent.
That's still a lot of money, and such reassurances haven't dispelled the concerns.
"The intent of the Affordable Care Act is to make sure that all Americans have access to quality, affordable health care," said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. He adds that there is a danger that the insurance marketplaces "will discriminate against the patients with the highest medical need. That would completely undermine the spirit of the ACA."
The group has been joined by Rep. Doris Matsui, D-Calif., in urging state officials to reconsider the policy. The high copays "could prevent many patients from receiving the lifesaving treatments they need because of prohibitively high cost," Matsui wrote to the state.
The problem with costly drugs is similar to another money issue with the health care law - a provision that could price millions of smokers out of coverage. Insurers are allowed to charge tobacco users buying an individual policy up to 50 percent higher premiums. For a 55-year-old smoker, the penalty could reach nearly $4,250 a year, on top of the standard premium. California is trying to override that problem by passing its own law. There's also pending state legislation to address some issues with prescription costs, but its prospects are unclear.
Meanwhile, leukemia patient Lisa Lusk worries about what will happen to her. A nursing assistant who lives near Fresno, Lusk is hoping to return to work in the next few months. When that happens, she expects to lose emergency coverage she's now getting through the state. And the medication Lusk takes to manage her chronic form of the disease costs more than $5,000 a month.
"I'm scared that when I get a job my copay may be more than $1,500 a month," said Lusk. "I'll just be working to pay for my medications."
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
2 NEW VIRUSES COULD BOTH SPARK GLOBAL OUTBREAKS
Monday, 13 May 2013 11:11 Published in Health & Fitness
LONDON (AP) -- Two respiratory viruses in different parts of the world have captured the attention of global health officials - a novel coronavirus in the Middle East and a new bird flu spreading in China.
Last week, the coronavirus related to SARS spread to France, where one patient who probably caught the disease in Dubai infected his hospital roommate. Officials are now trying to track down everyone who went on a tour group holiday to Dubai with the first patient as well as all contacts of the second patient. Since it was first spotted last year, the new coronavirus has infected 34 people, killing 18 of them. Nearly all had some connection to the Middle East.
The World Health Organization, however, says there is no reason to think the virus is restricted to the Middle East and has advised health officials worldwide to closely monitor any unusual respiratory cases.
At the same time, a new bird flu strain, H7N9, has been infecting people in China since at least March, causing 32 deaths out of 131 known cases.
WHO, which is closely monitoring the viruses, says both have the potential to cause a pandemic - a global epidemic - if they evolve into a form easily spread between people. Here's a crash course in what we know so far about them:
Q: How are humans getting infected by the new coronavirus?
A: Scientists don't exactly know. There is some suggestion the disease is jumping directly from animals like camels or goats to humans, but officials are also considering other sources, like a common environmental exposure. The new coronavirus is most closely related to a bat virus, but it's possible that bats are transmitting the disease via another source before humans catch it.
Q: Can the new coronavirus be spread from human to human?
A: In some circumstances, yes. There have been clusters of the disease in Saudi Arabia, Jordan, Britain and now France, where the virus has spread from person-to-person. Most of those infected were in very close contact, such as people taking care of a sick family member or health workers treating patients. There is no evidence the virus is spreading easily between people and all cases of human-to-human transmission have been limited so far.
Q: How are people catching the bird flu H7N9?
A: Some studies suggest the new bird flu is jumping directly to people from poultry at live bird markets. Cases have slowed down since Chinese authorities began shutting down such markets. But it's unclear exactly what kind of exposure is needed for humans to catch the virus and very few animals have tested positive for it. Unlike the last bird flu strain to cause global concern, H5N1, the new strain doesn't appear to make birds sick and may be spreading silently in poultry populations.
Q: What precautions can people take against these new viruses?
A: WHO is not advising people to avoid traveling to the Middle East or China but is urging people to practice good personal hygiene like regular hand-washing. "Until we know how and where humans are contracting these two diseases, we cannot control them," said Gregory Hartl, WHO spokesman.
Q: Which virus should we be more worried about?
A: It's impossible to know. "We really don't want to play the game of predicting which virus will be more deadly than the other," Hartl said. At the moment, both are worrisome since so little is known about how they are infecting humans and both appear to cause severe disease. "Any virus that has the ability to develop the capacity to spread from human to human is of great concern to WHO," he said.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Last week, the coronavirus related to SARS spread to France, where one patient who probably caught the disease in Dubai infected his hospital roommate. Officials are now trying to track down everyone who went on a tour group holiday to Dubai with the first patient as well as all contacts of the second patient. Since it was first spotted last year, the new coronavirus has infected 34 people, killing 18 of them. Nearly all had some connection to the Middle East.
The World Health Organization, however, says there is no reason to think the virus is restricted to the Middle East and has advised health officials worldwide to closely monitor any unusual respiratory cases.
At the same time, a new bird flu strain, H7N9, has been infecting people in China since at least March, causing 32 deaths out of 131 known cases.
WHO, which is closely monitoring the viruses, says both have the potential to cause a pandemic - a global epidemic - if they evolve into a form easily spread between people. Here's a crash course in what we know so far about them:
Q: How are humans getting infected by the new coronavirus?
A: Scientists don't exactly know. There is some suggestion the disease is jumping directly from animals like camels or goats to humans, but officials are also considering other sources, like a common environmental exposure. The new coronavirus is most closely related to a bat virus, but it's possible that bats are transmitting the disease via another source before humans catch it.
Q: Can the new coronavirus be spread from human to human?
A: In some circumstances, yes. There have been clusters of the disease in Saudi Arabia, Jordan, Britain and now France, where the virus has spread from person-to-person. Most of those infected were in very close contact, such as people taking care of a sick family member or health workers treating patients. There is no evidence the virus is spreading easily between people and all cases of human-to-human transmission have been limited so far.
Q: How are people catching the bird flu H7N9?
A: Some studies suggest the new bird flu is jumping directly to people from poultry at live bird markets. Cases have slowed down since Chinese authorities began shutting down such markets. But it's unclear exactly what kind of exposure is needed for humans to catch the virus and very few animals have tested positive for it. Unlike the last bird flu strain to cause global concern, H5N1, the new strain doesn't appear to make birds sick and may be spreading silently in poultry populations.
Q: What precautions can people take against these new viruses?
A: WHO is not advising people to avoid traveling to the Middle East or China but is urging people to practice good personal hygiene like regular hand-washing. "Until we know how and where humans are contracting these two diseases, we cannot control them," said Gregory Hartl, WHO spokesman.
Q: Which virus should we be more worried about?
A: It's impossible to know. "We really don't want to play the game of predicting which virus will be more deadly than the other," Hartl said. At the moment, both are worrisome since so little is known about how they are infecting humans and both appear to cause severe disease. "Any virus that has the ability to develop the capacity to spread from human to human is of great concern to WHO," he said.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
ST. LOUIS (AP) -- Jaime Garcia got rocked again by Colorado and fell well short of giving the St. Louis Cardinals three straight pitching gems.
"I made a couple mistakes and paid the consequences," Garcia said after allowing two homers that accounted for five runs in an 8-2 loss to the Rockies on Sunday. "Those guys had been doing an unbelievable job and you want to be able to continue a good thing."
Jorge De La Rosa held the Cardinals hitless into the seventh inning and Troy Tulowitzki's three-run homer ended Colorado's scoreless streak at 28 innings.
De La Rosa did not give up a hit until David Freese's two-out single in the seventh, answering a pair of outstanding performances by St. Louis starters Shelby Miller and Adam Wainwright over the weekend.
"Jaime definitely had a couple of pretty tough acts to follow," manager Mike Matheny said. "We know this is a good-hitting team, we know they're capable of jumping on you and putting up a lot of runs in a hurry. It happened today."
Garcia (4-2) had won three straight starts with a 1.25 ERA and no homers allowed in that stretch of 21 2-3 innings before running into the Rockies. He gave up five runs over six innings and fell to 0-3 with a 10.53 ERA - his highest against any opponent - in four starts against Colorado.
The left-hander entered as the career ERA leader at 8-year-old Busch Stadium at 2.41 but was undone by a changeup that stayed up in the zone against Tulowitzki in the third and a hanging curveball against Charlie Blackmon, who struck out in his first two at-bats, that went for a two-run homer in the sixth.
The Rockies and Marlins are the only National League teams Garcia hasn't beaten.
"How many starts have I made against them? Today was my fourth one?" Garcia said. "Obviously, they have a really good lineup, but I don't think about those things."
Garcia gave up just two homers in his first seven starts and entered with a 2.25 ERA overall.
Jordan Pacheco doubled with one out in the first to stop a 34-inning drought since Colorado's last extra-base hit, according to STATS. The Rockies finished with five extra-base hits, including a two-run double by pinch-hitter Reid Brignac off Carlos Martinez in the eighth.
The Rockies snapped a four-game skid and finished with 11 hits after totaling three in consecutive shutout losses to Miller and Wainwright.
Nolan Arenado, who singled with one out in the eighth to break up Wainwright's no-hit bid Saturday, was among four Rockies with two hits apiece.
The Cardinals lost for just the second time in 11 games. Matt Adams' RBI single off Matt Belisle in a two-run ninth, one of three hits by pinch-hitters, ended Colorado's shutout bid.
De La Rosa (4-3) struck out seven and allowed two hits in seven innings, baffling the Cardinals until Freese singled sharply to right off the glove of a diving Pacheco at first base. Jon Jay followed with a double. De La Rosa finished his longest outing of the season, and his best showing on the road by far, by getting Pete Kozma on a lineout to first.
De La Rosa entered 1-3 with a 5.13 ERA on the road and 2-0 at home with 12 scoreless innings. This was the fourth time he worked six or more scoreless innings.
Tulowitzki's eighth homer stopped the Rockies' scoreless streak two innings shy of the team record. They went 30 innings without a run from Sept. 30 to Oct. 3, 2010, according to STATS.
The Rockies entered the weekend with the top offense in the National League and still led with a .266 batting average going into the finale of the three-game series. Tulowitzki was 0 for 6 in the first two games with five strikeouts and Carlos Gonzalez had been hitless in 15 at-bats before finishing with two singles and a walk.
Blackmon batted eighth after being called up earlier in the day to replace Michael Cuddyer, placed on the 15-day disabled list with a neck injury. He got unexpected cheers after hitting his fourth career homer - he was introduced in his first at-bat as a player making his major league debut.
Colorado had five hits in the first three innings after totaling three and going 40 consecutive at-bats without a hit the previous two days. The Rockies have never been shut out three straight times.
The Cardinals' streak of retiring 40 straight batters is tied for the second-longest in the majors since 1974, two shy of the record set by the Seattle Mariners from Aug. 14-17 last year, with Felix Hernandez throwing a perfect game on Aug. 15. Rangers pitchers retired 40 in a row in 1996.
NOTES: Gonzalez had two singles and a walk and is 6 for 12 against Garcia. ... Cardinals pitchers had a 2.02 ERA over the previous 10 games. ... Cardinals C Yadier Molina was 0 for 3, ending an 11-game hitting streak. He had five hits in the first two games of the series.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
"I made a couple mistakes and paid the consequences," Garcia said after allowing two homers that accounted for five runs in an 8-2 loss to the Rockies on Sunday. "Those guys had been doing an unbelievable job and you want to be able to continue a good thing."
Jorge De La Rosa held the Cardinals hitless into the seventh inning and Troy Tulowitzki's three-run homer ended Colorado's scoreless streak at 28 innings.
De La Rosa did not give up a hit until David Freese's two-out single in the seventh, answering a pair of outstanding performances by St. Louis starters Shelby Miller and Adam Wainwright over the weekend.
"Jaime definitely had a couple of pretty tough acts to follow," manager Mike Matheny said. "We know this is a good-hitting team, we know they're capable of jumping on you and putting up a lot of runs in a hurry. It happened today."
Garcia (4-2) had won three straight starts with a 1.25 ERA and no homers allowed in that stretch of 21 2-3 innings before running into the Rockies. He gave up five runs over six innings and fell to 0-3 with a 10.53 ERA - his highest against any opponent - in four starts against Colorado.
The left-hander entered as the career ERA leader at 8-year-old Busch Stadium at 2.41 but was undone by a changeup that stayed up in the zone against Tulowitzki in the third and a hanging curveball against Charlie Blackmon, who struck out in his first two at-bats, that went for a two-run homer in the sixth.
The Rockies and Marlins are the only National League teams Garcia hasn't beaten.
"How many starts have I made against them? Today was my fourth one?" Garcia said. "Obviously, they have a really good lineup, but I don't think about those things."
Garcia gave up just two homers in his first seven starts and entered with a 2.25 ERA overall.
Jordan Pacheco doubled with one out in the first to stop a 34-inning drought since Colorado's last extra-base hit, according to STATS. The Rockies finished with five extra-base hits, including a two-run double by pinch-hitter Reid Brignac off Carlos Martinez in the eighth.
The Rockies snapped a four-game skid and finished with 11 hits after totaling three in consecutive shutout losses to Miller and Wainwright.
Nolan Arenado, who singled with one out in the eighth to break up Wainwright's no-hit bid Saturday, was among four Rockies with two hits apiece.
The Cardinals lost for just the second time in 11 games. Matt Adams' RBI single off Matt Belisle in a two-run ninth, one of three hits by pinch-hitters, ended Colorado's shutout bid.
De La Rosa (4-3) struck out seven and allowed two hits in seven innings, baffling the Cardinals until Freese singled sharply to right off the glove of a diving Pacheco at first base. Jon Jay followed with a double. De La Rosa finished his longest outing of the season, and his best showing on the road by far, by getting Pete Kozma on a lineout to first.
De La Rosa entered 1-3 with a 5.13 ERA on the road and 2-0 at home with 12 scoreless innings. This was the fourth time he worked six or more scoreless innings.
Tulowitzki's eighth homer stopped the Rockies' scoreless streak two innings shy of the team record. They went 30 innings without a run from Sept. 30 to Oct. 3, 2010, according to STATS.
The Rockies entered the weekend with the top offense in the National League and still led with a .266 batting average going into the finale of the three-game series. Tulowitzki was 0 for 6 in the first two games with five strikeouts and Carlos Gonzalez had been hitless in 15 at-bats before finishing with two singles and a walk.
Blackmon batted eighth after being called up earlier in the day to replace Michael Cuddyer, placed on the 15-day disabled list with a neck injury. He got unexpected cheers after hitting his fourth career homer - he was introduced in his first at-bat as a player making his major league debut.
Colorado had five hits in the first three innings after totaling three and going 40 consecutive at-bats without a hit the previous two days. The Rockies have never been shut out three straight times.
The Cardinals' streak of retiring 40 straight batters is tied for the second-longest in the majors since 1974, two shy of the record set by the Seattle Mariners from Aug. 14-17 last year, with Felix Hernandez throwing a perfect game on Aug. 15. Rangers pitchers retired 40 in a row in 1996.
NOTES: Gonzalez had two singles and a walk and is 6 for 12 against Garcia. ... Cardinals pitchers had a 2.02 ERA over the previous 10 games. ... Cardinals C Yadier Molina was 0 for 3, ending an 11-game hitting streak. He had five hits in the first two games of the series.
© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
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