I recently received a memo from our personnel director detailing changes to our health care plan with Oxford Health Plans. Our agency, a small non-profit contract agency with the city, faced with budget cuts and increases in their insurance premiums was forced to make changes to our plan. The result is a huge increase in the cost of prescription drugs which is felt by everyone and most of all the mentally ill.
In an ominous sign for all chronic medication users, especially consumers who often have limited incomes, Oxford created a three-tiered formulary for prescription drug co-payments. This is one of the options to reduce the cost of prescriptions that is gaining popularity among insurance companies. (Some companies have a four- or five-tiered approach while others are reinstituting reimbursement on a percentage basis). The basis for the plan is that a member would pay a small co-pay for generics, a modest co-pay for brand name drugs that are on the insurance company's recommended list, and a high co-pay for name-brand drugs that are not on the recommended list. The goal is to try to retain quality coverage at an affordable price. Unfortunately that is not the case for consumers who will be paying stiff increases in prescription costs.
Instead of the $5 for generic drugs and $10 for brand name drugs I used to pay, Oxford has created a list of "preferred drugs," which means that for drugs on the list the co-payment is $10 for generic and $20 for brand name drugs-an increase of 100%. But for drugs not on the list the cost is $35 per prescription, a whopping 350% increase. Both of the medications I take for bipolar disorder, Depakote ER and Seroquel are not on the list and will cost $35 a month each instead of $10. That means I am paying $840 a year for my medication or $600 a year more. (Just two years ago I was paying only $80 a year for 90-day mail order prescriptions of my previous medications. My new medications are not on the mail order list). This makes me think about those that are on several medications and the costs to them.
Because consumers are often dependent on newer drugs with fewer side effects to control their illnesses, this new trend is particularly alarming. Since the insurance companies' primary objective is to control costs, newer drugs will be left off the lists until their patents run out and other companies may apply to the Food and Drug Administration (FDA) to make generic versions of the drug. As long as the original brand remains patented, generic versions of the drug will not be available. Today's drug patents run for 20 years, although the Food and Drug Administration's approval process eats up half or more of that protection. That is too long to wait for cheaper version of a drug you need now.
A large number of psychiatric drugs are missing from the list of about 725 generic and brand name "preferred drugs." This discriminates against consumers and makes me angry. The medications I take, Depakote ER (approved August 2000) and Seroquel (approved December 1997) are not available in generic form yet. The most popular psychiatric drugs, antidepressants, are covered only in their generic form in nearly every instance. Prozac is covered as a generic (for $10) but newer antidepressants like Celexa are not on the approved list and cost $35 a prescription. Of the nearly 20 antidepressants I checked, over half were not on the approved list.
I have been on my new medications for 18 months and they have dramatically improved my quality of life, making me a much more prolific worker and increasing my creativity, stability, and ability to handle stress and have good relationships and friendships. My self-esteem has never been higher and I am stronger physically and emotionally. I have not taken a sick day since, and tension headaches that used to plague me have almost disappeared completely. I have just redesigned my department's website which will be online as of early October 2002 and I have been working as a volunteer cameraman for the Manhattan Neighborhood Network and as a Copy Editor and Editorial Board member of New York City Voices. How ironic it is that the very medications that made my life so much more enjoyable and made me a more productive member of society are costing me so much more money. The insurance companies don't realize how my being healthy has saved them money in doctor visits and extra prescriptions from physical illnesses.
I have never doubted that insurance companies have targeted consumers but seeing this formulary is sobering. And Medicare and Medicaid have been developing formularies of their own. This country is in a health care crisis and the government is doing nothing about it. As long as the insurance companies are able to control the health care industry, there will never fairness in who gets health care and at what cost. I have always supported national health care as the best way to insure everyone on a fair basis and control costs in the long run. These new trends in health care are another step backward and further illustrate the ever-increasing need for government intervention and regulation of the industry.