Bill seeks to cap prescription copays

FRANKFORT, Ky. (WHAS11) – It's a new practice being used to contain health care costs but does "co-insurance" threaten to put medications financially out of reach for Kentucky's sickest patients?

It's not just the medication Julie Davis takes daily to prevent epileptic seizures, but the arsenal of pills to counteract that drug's side effects.

"I have a 7 o'clock alarm on my phone so I don't forget the time – my husband has an eight o'clock alarm so he doesn't forget the time," Julie said.

With any slight change in formula, your side effects can become absolutely intolerable.

Shortly after Davis switched insurance plans last May, her insurer, despite the concerns of her neurologist, switched her from the drug that effectively treated her condition to a generic drug.

Any impact or tweak can have a difference.

Within three months, her seizures resumed so Julie decided to return to the name brand drug that worked for her.

"I found out that my copay was going to be – over $1200," she said.

A staggering co-pay, an example of the co-insurance practice by insurance companies to offset rising health care costs by transferring them to their customers -- a motivation to shift to cheaper drugs when they conclude the more expensive ones are not medically necessary.

"I have some outsider claims adjuster that's telling me it's not," she said.

Unable to afford the equivalent of a house payment for her medication, Julie takes the generic -- and worries about the future of her family.

"They need their Mommy around and my husband and I, we fear every day that they may not grow up with a Mom," Julie said.

Two bills filed in Frankfort would cap the patient's cost of prescription drugs at $100 a month per drug or $200 a month for all drugs.

"It should never be to the point where someone has to choose between whether they're going to put food on the table or whether they're going to buy a prescription drug for their loved one," Rep. James Kay said.

Yet the Kentucky Association of Manufacturers predicts a cap the copay law would backfire - increasing the monthly premiums paid by Kentucky businesses and individuals.

"The private sector continues to pick that up and then when other costs are being put out there that we have to help through our plans to subsidize and cover, it just puts more and more pressure on the ability for us all to move forward together," Greg Higdon of the Kentucky Association of Manufacturers said.

Stuck in the middle are Kentuckians like Julie Davis - who is staying on generics, working from home and praying.

"I just pray to God I don't have another seizure," Julie said.

The Senate version of Cap the Copay was heard in committee Wednesday but has not yet received a vote.


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