Cancer

Coupons Vs. Co-Pays - How Insurance and Drug Companies Battle for Money

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If you ask someone about their health insurance, they will probably tell you about their co-pays as one of the first topics. "My co-pays went up for seeing a specialist." "My prescriptions cost me so much." "I hope the new health care co-pays are much lower."

Face it; co-pays are only one component of your insurance. A high co-pay for a doctor visit may cause people to see doctors less frequently - I saw some study on that recently. But if you don't want to pay a high co-pay, insurance companies would be happy to raise your premium instead. You will pay the same overall either way.

Co-pays are higher for seeing specialists in an effort to get people to see their primary care physician first. Co-pays for an emergency room visit are very high - maybe $500 - if you aren't hospitalized. This is because they want you to see your primary care physician during the day time. Also, they want you to stay in network with doctors with whom they have negotiated prices.

Co-pays are high for brand-name drugs because insurance companies want people to at least try the generic version of a drug instead of the brand-name one.

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Insurance companies are working on controlling their costs by making the path of least (and cheapest) resistance the lower-cost medical alternative. They are also trying to motivate the general public into getting into shape and into getting physicals and screening tests in an effort to keep us all healthier.

Now drug companies are trying to beat the co-pay system so people take their more expensive brand-name drugs instead of the generics by offering coupons to the public. With a coupon, the patient's co-pay on a brand-name prescription is the same as for a generic. And the insurance companies shoulder the additional cost. The patient doesn't see any difference. The drug company gets to sell the brand-name drug and its additional profits. And the insurance companies are stuck with the huge cost.

I currently take five daily prescriptions, plus a few others "when needed." Of the five, two are brand name only, no generic available. For one of them, if I get it at the local pharmacy, the co-pay is $105 for a month's supply. If I fill the prescription through the mail-order pharmacy, it is a more affordable $65 for a three-month supply. For the other, the monthly cost is approximately $2000 (really). I don't know what my co-pay will be because I started taking it after I maxed out my insurance for the year. I will be switching to the mail-order pharmacy this year.

I am happy to work with the co-pay system. I make sure I stay in network as well. I am trying to keep my costs down too.