Law & Governance
Seismic shift in cancer drug funding to private payers
Private insurance plays a critically important role in assuring access to medically necessary prescription drugs. Like government plans, employers face many cost pressures, but unlike public plans, there is no requirement to provide these benefits.
"Costs have escalated at about 400% of the Consumer Price Index over the last 22 years," says Chris Bonnett, president, H3 Consulting. "Particularly in this economic climate, relatively open access and willingness to continue funding their $9 billion stake will be sorely tested."
Health benefit plans are funded most often by employers, but frequently employees have a significant cost-sharing role. For smaller plans, the insurer takes the full risk, but larger employers (over 100 employees) typically self-insure their drug plans, and therefore have the final say on what and who is covered, and what coverage exclusions exist.
The CAC says the bigger issue is that a reasonable 20% co-pay on a $60 average drug becomes unaffordable when the drug costs $25,000 or more and suggests that pooling high cost drug claims - often catastrophic to patients and their families - is an idea whose time is long overdue.
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