Standard co-payments are often doubling for drugs that patients have been using for years. Drugs may be omitted, or dropped, from such lists because they are deemed nonessential, like those for male impotence, baldness or wrinkles, or to help people quit smoking. But in many cases, insurers are refusing to endorse more costly new versions of life-sustaining drugs when cheaper alternatives exist. Those questions are open to debate.
Drug makers insist that their new drugs are better and have fewer harmful side effects.
By pushing cheaper, older drugs, they say, health plans ultimately drive up costs for hospital stays, nursing homes and doctors. Employers and managed care executives counter that they must slow the explosive spending for prescription drugs, which rose 15 to 20 percent in each of the last two years as an array of costly new drugs hit the market. But when she was forced recently to switch her Medicare health plan to Aetna U.S. Healthcare, she found neither drug on the list. In a letter to members in small businesses, Oxford Health Plans explained the new system, using blood pressure drugs as an example. Even small increases hurt.