WASHINGTON _ At several thousands of dollars adose, such commonly prescribed biotech drugs asBetaseron and Neupogen can quickly eat away at apatient's health insurance lifetime caps. The cost of thesedrugs, along with the frequent hospitalizations that thechronically ill must endure, often consume the $1 millioncap on health care expenditures imposed by healthinsurers.
The upshot is that many chronically ill patients are forcedto claim coverage under Medicaid, state run health plansthat are notorious for slim benefits and slimmerreimbursements. The alternative, as supported byCambridge, Mass.-based Genzyme Corp., and theBiotechnology Industry Organization (BIO), is legislationto prohibit these lifetime caps. They are lobbying forlegislation sponsored by Sen. James Jeffords (R-Vt.) thateliminates lifetime caps and permits continued access forthe chronically ill to the private health insurance market.
Jeffords' bill also is supported by a number oforganizations representing the chronically ill, includingthe Alliance for Aging Research, Cystic FibrosisFoundation and AIDS Action Council.
The biotech industry has thrown its support behind thebill "because it affects access to new technology," saidDavid Foster, a Genzyme spokesman.
A study published in the Oct. 25, 1995, Journal of theAmerican Medical Association showed that fewerAmericans are adequately insured for the cost ofcatastrophic illness. As catastrophic costs have gone up,private health insurance plans have not kept up with thepace. The study's authors estimated that 29 millionpeople under the age of 65 are underinsured for acatastrophic illness, up 50 percent from the estimatecontained in a similar study published 10 years ago.
According to a report cited by Genzyme (1993 NationalUnderwriters Life & Health: Financial Services Edition),many health insurers are increasing the lifetime caps onthe health policies from $1 million to $2 million andsometimes even $5 million to offer their subscriberspeace of mind. From an actuarial point of view, increasedpremium costs are trivial, according to the company.
In a Nov. 28, 1995, letter to Jeffords, the biotechorganizations and chronic disease patient advocatesargued that eliminating lifetime caps was warranted on anumber of points. A $1 million cap set in 1979 is worth$10 million to $15 million today. Those insurancecompanies that have raised their caps to $6 million oreliminated them altogether have reported only "trivialincreases in their premium costs . . ." stated the letter.
The organizations estimated that 10,000 patients willexceed their lifetime caps in the next five years. Thealternative is often seeking Medicaid coverage. "Whilewaiting for a determination of [Medicaid] eligibility,many patients are forced to go without medical treatmentof their serious conditions."
Jeffords will offer his bill as the floor amendment tohealth insurance market reform legislation sponsored bySens. Nancy Kassebaum (R-Kan.) and Edward Kennedy(D-Mass.). Their bill, the Health Insurance Reform Act(S. 1028), addresses two major concerns about the privatehealth insurance market. Permitting individuals totransfer their insurance from one job to another _portability of coverage _ will prevent gaps in care. Thebill also prohibits insurers from excluding individualsfrom coverage because of preexisting conditions. S. 1028was unanimously reported out of the Senate Labor andHuman Resources Committee in August. No date forfloor action has been set. n
-- Michele L. Robinson Washington Editor
(c) 1997 American Health Consultants. All rights reserved.