'Specialty Drugs' Designation Leaves Patients With Prescription Sticker Shock

DENVER (CBS4/KPIX) – Millions of Americans are suffering from sticker shock after refilling their prescriptions. Most major health insurers are quietly changing their prescription drug plans and forcing consumers to pay a larger percentage of the total drug cost instead of a set co-pay.

Until recently, insurance companies had a set price for generics and for brand name drugs, but as CBS4 partner KPIX-TV in San Francisco reported, most insurance companies have recently added another category for the priciest prescriptions called "specialty drugs."

Some of the drugs now classified in the new category include medications to treat cancer, arthritis, Chron's disease, hepatitis, HIV, multiple sclerosis and depression.

Insurance companies claim that creating the "specialty drugs" category is a way to pass along the skyrocketing cost of the most expensive drugs to the people who actually use them, instead of increasing the co-pays and premiums for everyone.

For people like Kerry Edgell, who relies on an anti-depressant which is now classified as a specialty drug, the change is creating financial hardships.

"You expect costs to go up, but not five times," said Edgell. "My copays have gone up from $45 to $226 and some change because they moved the medication from Tier 3 to Tier 5."

Consumers who find themselves in this predicament often have options. In some cases doctors can prescribe a generic drug or comparable medication to lower the cost.

However, some generics are now classified as specialty drugs. In that case, it may actually be cheaper for the consumer to go with the brand name drug.

Many drug companies are now offering co-pay assistance programs which entice consumers to stick with the brand name drug by helping to pay out-of-pocket costs. Some co-pay assistance programs are geared towards low income consumers, while others don't have any income caps. Most co-pay assistance do not accept patients on Medicare.