We hear frequently about how higher rates charged by health insurers impact people's access to medical treatment. But what about the pharmaceutical side of things?

People with diabetes were notified the other day by insurance giant UnitedHealthcare that one of the most widely prescribed insulins, NovoLog, is switching from the company's Tier 1 drug list to Tier 3.
That means it's moving from the cheapest category of drugs to the most expensive.
This might not be such a big concern in cases in which generic versions of a brand-name drug are available. But that's not the case with state-of-the-art, fast-acting insulins. They have no generic equivalents.
UnitedHealthcare's repricing of NovoLog illustrates the vulnerability of people who depend on prescription medications to keep them well. In such cases, the patient's medical interests can take a back seat to the insurer's bottom line.
“This isn't about medicine,” said Dr. Anne Peters, director of USC's Clinical Diabetes Program. “It's about finance.” UnitedHealthcare is telling NovoLog users that they can avoid a price hike by switching to another insulin, Humalog, which will move from the pricier Tier 3 to Tier 1. But Peters said this isn't always a good idea.
NovoLog and Humalog are similar, but they're not identical. “There are many people who do well with one but not the other,” Peters said. “As a doctor, I would tell patients that if you're doing OK with a drug, you shouldn't change it.”
UnitedHealthcare is thus putting many diabetics in the position of having to choose between paying a significantly higher price for the medication favored by their doctor or accepting the cheaper (and potentially less-effective) alternative preferred by the insurer.
For me, this issue isn't just academic. UnitedHealthcare is my employer-provided insurer, and I have Type 1 diabetes. I've been on NovoLog — at my doctor's recommendation — since my disease was diagnosed three years ago.
As a Tier 1 drug, NovoLog costs me a $20 co-pay when I buy a one-month supply that would otherwise cost about $113.
When NovoLog moves Jan. 1 to Tier 3, my monthly copay will rise to $70, increasing my annual out-of-pocket expense for insulin 250% to $840. That's on top of the thousands of dollars I have to pay each year for blood-sugar testing supplies, insulin-pump gear and doctor visits.
Many health plans split the difference by putting both NovoLog and Humalog in Tier 2 with identical co-pays. That way, the decision on which insulin to use remains a medical choice by the patient and his or her doctor. Anthem Blue Cross does it like this. So does Aetna.
So why is UnitedHealthcare putting people like me in such an untenable position?
Tim Heady, who runs UnitedHealthcare's pharmaceutical operations, insisted the company is acting in patients' best interest by offering at least one insulin in Tier 1. To do this, he said UnitedHealthcare creates a “competitive situation” among drug companies.
In other words, the company engineers a bidding war. The company that bids lowest gets to be in Tier 1. The losing bidder moves all the way to Tier 3.
The problem is: What if the maker of your drug isn't the lowest bidder? Then you're either going to pay much higher costs or you're going to switch to whatever UnitedHealthcare wants you to take, regardless of your doctor's preference.
(Source: Latimes.com)