Insurance company's policy change will increase health care costs for some chronically ill


(KUTV) -- Imagine not being able to afford the medicine you need to live - all because of a policy change at your insurance company. That’s the situation facing a Provo woman who decided it was time to Get Gephardt to investigate.

Lisa Baird has multiple sclerosis. She says that the medication that helps her stay healthy is approximately $5200/month.

The good news for Lisa is that the drug's manufacturer offers a copay assistance program. The drug maker pays some of the cost and the portion Lisa pays goes toward her annual insurance deductible.

Or, it used to.

Her insurance company, United Healthcare, says, no more. Because Lisa is getting a discount from the drug maker, he payments will no longer be applied to her deductible, she says she was told.

It's a policy chance that will cost Lisa thousands of dollars more per year.

When Lisa protested, she says United Healthcare told her that allowing the amount paid by the drug-maker’s-coupon to count towards her deductible was “not fair to the healthy people."

Lisa says that answer shocked her, after all, she certainly doesn't want to be sick.

"Now they're being profitable at the expense of sick people and that makes me really angry," she said.

United Healthcare declined an on camera interview, but in a statement, confirmed the policy change.

“In general, drug coupons contribute to rising health care costs by incentivizing patients to choose a higher-priced option," a spokesperson wrote.

United Healthcare says its decision to drop drug coupon payments from affecting a patient's deductible was modeled after a similar federal government policy.

Lisa’s plight has gained the attention of state lawmakers. Sen. Curt bramble, Chairman of the Utah business and labor committee, told Get Gephardt Tuesday that issue "will be on the agenda" in an upcoming meeting.

But Sen. Bramble cautions it won't be an easy fix, echoing United Healthcare's sentiment that drug prices are out of control which drives up costs for everybody.

Lisa says the policy change could leave her forced to abandon her medication because she simply doesn't have the means to pay thousands of dollars more per year for healthcare than she’s been paying.

"It might sound dramatic, but it's a death sentence," she said.

The maker of Lisa's drug tells Get Gephardt that United Healthcare’s decision isn't unique. They are seeing similar policies becoming the trend with insurance companies.

Clip 1588 lisa baird

:32 i found out that our insurance company is no longer applying the copay assist money that they get from my medication i take, which is a really expensive medication :41 and (you're sick) yes i have ms, i have multiple sclerosis :46 and so the medication that helps me to stay healthy is um approximately $5200 a month

:57 we can't afford my husband and i can't afford that, and so luckily shared solutions, which makes the drug, they um, they offer a copay assist program, and so 1:08 all i do is i just order the medication, and it has to be done through their pharmacy, and then they pay the copay on it for me so that i don't have to pay the $5200 so with the 1:24 insurance company that we're with right now ,it's a high deductible plan, it's through my company, and so i have to pay 100% of everything until we meet the deductible and then we can 1:37

3:02 the whole time they've been applying it to the deductible, and then it's this year that they stopped applying it to the deductible 3:07 (why?) They made a new policy at united health care, where our insurance is at, and they made a new policy that they would no longer apply any copay assist money to the deductible for patients 3:22

3:46 she said it's not fair to the healthy people (what's not fair to the healthy people?) That i get copay assist 3:54 and so money's being paid by somebody else to help us and since i'm not

4:13 (is that fair?) I don't think so

4:20 it's not fair to me, it's not fair to anybody with ms or diabetes or any other illness that takes a lot of money to take the medication 4:31 so you know i called the insurance commission about it also

5:07 i go to get my medicine and it's $5200 a month. What's fair about that? That's not fair to anybody

6:18 there's a lot of people out there who are sick like me or my husband has diabetes, and their insurance companies are going to start doing this, this isn't just united health care right now, there are other 6:28 insurance companies

7:00 now they're being profitable at the expense of sick people and that makes me really angry

7:36 i couldn't walk, it made my legs feel really heavy, you get this feeling in your body it's like you're falling asleep, so like 7:42 you know how your foot falls asleep and it comes out and it's got that prickly feeling at the bottom of it? That's how you feel all the time, and 7:50

8:24 i had a really bad episode, when i walked, i had to walk with a cane, my foot was dragging, i couldn't write very well, my hands were very spastic 8:34

8:57 (this policy, does it put you in a position you might have to go off the drug?) Mhmm, oh yeah

9:12 we probably spend about $13,000 a year on his medications

9:34 for both of us, if we're not on our medication, and it might sound dramatic, but it's a death sentence beause we will eventually die from complications of ms or diabetes 9:46 sooner than we normally would have had we been on our medications

Clip 1600 @ 15:23 "opens box"

Clip 1619 @ 20:01 "we just do our puzzles"

Clip 1627 @ 22:18 "puzzle"

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