Check out the entire series here.

Let’s talk about the column that is NOT discussed in this table (from a manufacturer’s advertisement previously posted), and that is the patient responsible portion. I added a column to represent the patient co-pay if the patient does not have a secondary insurance. Have I got the math right on these numbers?

I want to know what happens to the patients who don’t’ have a secondary insurance to cover that 20%. In fact, I want to know which is the correct 20%:

  • Are Medicare beneficiaries without secondary insurance just not being treated with CTPs?
  • Or are elderly retirees without a secondary insurance spending their savings to pay these huge copays?
  • Or is the 20% that the patient owes being quietly written off because the doctor has made so much profit on the “rebates” that they don’t feel they need to collect it?
  • Most of all, I am curious to know if the 20% copay is calculated on the list price or the discounted priced and which of these numbers is being sent to the secondary insurance for payment?

Where I come from, we’d say that something about this seems as crooked as a dog’s hind leg. However, it’s possible that I just don’t understand it, so I hope you will explain it to me.

CTP Copay