Insurers make patients pay hundreds more for cancer, arthritis drugs

May 30 2012

Thousands of patients taking costly drugs for ailments such as cancer and rheumatoid arthritis are being asked to shoulder a greater share of the expense. In other news, consumers are demanding access to their medical device data. Others are harnessing the internet to jumpstart medical research and share important experiences, including serious illnesses, with family and friends.

Los Angeles Times: Insurers Forcing Patients To Pay More For Costly Specialty Drugs
Thousands of patients in California and across the nation who take expensive prescription drugs every month for cancer, rheumatoid arthritis and other ailments are facing sticker shock at the pharmacy. Until recently, most of these patients typically paid modest co-pays for the advanced drugs. But increasingly, Anthem Blue Cross, Aetna and other insurers are shifting more prescriptions to a new category requiring patients to shoulder a larger share of the drug's cost. The result: Pharmacy bills are going up by hundreds of dollars a month -; on top of insurance premiums (Terhune, 5/29).

Los Angeles Times: Many Hospitals, Doctors Offer Cash Discount For Medical Bills
A Long Beach hospital charged Jo Ann Snyder $6,707 for a CT scan of her abdomen and pelvis after colon surgery. But because she had health insurance with Blue Shield of California, her share was much less: $2,336. Then Snyder tripped across one of the little-known secrets of healthcare: If she hadn't used her insurance, her bill would have been even lower, just $1,054. ... Unknown to most consumers, many hospitals and physicians offer steep discounts for cash-paying patients regardless of income. But there's a catch: Typically you can get the lowest price only if you don't use your health insurance (Terhune, 5/27).

The New York Times: Waking Up To Major Colonoscopy Bills
Patients who undergo colonoscopy usually receive anesthesia of some sort in order to "sleep" through the procedure. But as one Long Island couple discovered recently, it can be a very expensive nap. Both husband and wife selected gastroenterologists who participated in their insurance plan to perform their cancer screenings. ... And in both cases, the gastroenterologists were assisted in the procedure by anesthesiologists who were not covered by the couple's insurance. They billed the couple's insurance at rates far higher than any plan would reimburse -; two to four times as high, experts say (Rabin, 5/28).

Los Angeles Times: Facebook Group Helped With Cancer Support, Mourning
Karen North, director of USC's Annenberg Program on Online Communities, says that the practice of using online community tools to connect deeply with friends and family is on the rise. "People are engaging their loved ones for important life events including struggling with the challenges of an illness, sharing relationships and weddings, engaging others in the upbringing of their children -; showing pictures, telling stories, asking for advice or support, and more." Though Facebook has been criticized as a font of useless narcissism, this type of helpful sharing often feels very personal, especially if the creator includes pictures, videos and audio as well as text, North says (Williamson, 5/27).

NPR/KQED: Patients Crusade For Access To Their Medical Device Data
Each year, tens of thousands of Americans are implanted with tiny battery-controlled devices that regulate the beating of their hearts. Those devices transmit streams of medical data directly to doctors. But some patients, like Hugo Campos of San Francisco, fear they're being kept out of the loop. ... That's because even though Campos' ICD can wirelessly transmit data twice a day about his heart and the ICD itself, that information goes only to his doctor. Campos has to make an appointment and ask for a printout. And that, he says, just doesn't seem fair (Standen, 5/28). 

NPR: Patients Find Each Other Online To Jump-Start Medical Research
People with extremely rare diseases are often scattered across the world, and any one hospital has a hard time locating enough individuals to conduct meaningful research. But one woman with an extremely rare heart condition managed to do what many hospitals couldn't. Katherine Leon connected with enough people online to interest the Mayo Clinic in a research trial (Cuda-Kroen, 5/28). 

The New York Times: A Game To Help Doctors Ask Tough Questions
As Dr. Danielle McCarthy listens to a man beg for a prescription for painkillers, she weighs her possible responses. ... Their exchange is similar to conversations that take place on almost every shift at Northwestern Memorial Hospital here, Dr. McCarthy said. But it is fiction -; part of an interactive video game designed to train doctors to identify deceptive behavior by people likely to abuse prescription painkillers. The patient is an actor whose statements and responses are generated by the program (Johnson, 5/25). 

The Wall Street Journal: Long Medical Waits Prove Hard To Cure
Efforts in the medical world to reduce the amount of time patients spend waiting for appointments can have unintended consequences. If you measure how long patients coming off a waiting list have spent on that list, a hospital has little incentive, while under evaluation, to clear those who already have been waiting longer than average. As soon as they are cleared, the hospital's numbers get worse (Bialik, 5/25). 

Meanwhile, analysts predict the low use of medical services, which has boosted insurers' stocks, is unlikely to continue.

Reuters: Analysis: HMO Stocks May Struggle Over Health Claim Costs
Americans' low use of healthcare services has proved a boon to health insurers over the past two years, reducing medical claim costs and raising profits. The growing view on Wall Street is that those days are over. A series of first-quarter earnings disappointments for health insurers in the past month has damped hopes for a repeat of the profit windfalls that led to huge stock gains in 2011 (Krauskopf, 5/25).