High copays are an obstacle to health care

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As our policymakers work on broad-scale health care reform from the halls of government, many physicians have joined patients in demanding change.

As a neurologist who sees multiple sclerosis (MS) patients every day, I am worried that without reform, our current system will kill preventive care and continue driving up the cost of care. I know this because patients too often tell me that they aren't taking their medications or aren't following my advice for maintaining their health because they can't afford skyrocketing copays.

Copays are the fixed, out-of-pocket costs required by health insurers to be paid by patients for services such as exams at a clinic, outpatient procedures, physical therapy and the filling of prescriptions. These services are often preventive in nature -- for instance, preventing paralysis that would otherwise need constant, long-term medical attention, or preventing hospital stays with visits to the clinic for doctor-recommended checkups.

The idea behind copays is to reduce wasteful treatments by patients and health care providers, thereby reducing costs. But some copays have gotten out of control. Preventive medications for MS patients fall into the "fourth payment tier," which are more expensive to produce because they are naturally, rather than chemically, derived. These treatments prevent MS attacks and lessen long-term disability.

Insurance companies recently introduced this highest-priced tier and are categorizing more medications into the fourth tier all the time. In many cases, the copay for an MS medication can jump from $25 to $200 for a one-month supply, effectively denying patients access to needed medicines and preventive care...