Can Someone Explain the Math on the Patient Copay for CTPs (Skin Substitutes)?

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.