Sicker patients socked with higher copays

The New York Times said the new pricing system, which often charges patients 20 percent to 30 percent of the cost of the drugs, can add up to thousands of dollars each month for some people. The Tier 4 system is incorporated into 86 percent of Medicare drug plans and is included in 10 percent of private insurance plans, the newspaper said.

Private insurance companies said they began offering the Tier 4 plans at the request of employers. Critics say the program is poor social policy.

"This is an erosion of the traditional concept of insurance," Dan Mendelson of the research group Avalere Health told The Times. "Those beneficiaries who bear the burden of illness are also bearing the burden of cost."

Copyright 2008 by United Press International