This brings up an interesting question, what do you go for relief or bankruptcy?  Although now it is not real wide spread, but as the Biomed business continues to grow with new break throughs, how will this process continue?  Is this more justification for biosimilars, the Biomed side of generic drugs?  One study stated that these drugs account for only 1% of the drugs, but 15% of the cost. 

Even at the 4th tier, many of the drugs are still way of the reach of many.  Being this story is in Washington, what do the insurers have in reserve funds?  BD 

A new-generation medication, Copaxone, was really working for her. After two decades of being in and out of hospitals, Garcia was taking steps to work again. Her wallet, though, was in severe distress. Under her Medicare prescription plan, Garcia's share of the expensive drug was $330 per month. All together, medications were taking a third of her disability payments her only income and she couldn't swing it. Copaxone, Enbrel, Remicade: For some patients, such new-generation drugs, often called "biologicals" or "bioengineered" when they are created by genetically modified living cells, have performed magic. In some cases, they work when other drugs have failed, or for diseases that previously had no drug treatments at all. But they cost a lot often $2,000 to $3,000 per month.

The emergence of bioengineered drugs has dramatically magnified these disputes. Most are produced through complicated, delicate procedures that are difficult to replicate.

"It gets to the fundamental question of 'What is insurance?' " he said.  "If I end up having to pay for those last two infusions ... I would have to file for bankruptcy," she said.

Health | The newest generation of drugs: Who can afford them? | Seattle Times Newspaper

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