Many people are celebrating the passage of the health care bill. Others are urging their representatives to repeal it. Both sides of the aisle, though, are starting to recognize that the bill fails to address rising health care costs. But what about prescription drug prices?
 

Interestingly, drug prices aren't on the rise -- but the same cannot be said of patients' out-of-pocket costs, aka "co-pays." Over the past several years, insurance companies have become increasingly reluctant to pay for medications -- and ever-increasing co-pays are the insurance industry's weapon of choice.
 

Since 2000, prescription drug prices have mirrored inflation. According to the Labor Department, overall inflation has averaged about 2.5 percent annually, and prescription drug prices have gone up about 3.6 percent each year, over that time frame. Co-pays, though, have increased four times faster than inflation.
 

Where's the logic and where's the sense? Increasing co-pays at the local pharmacy may save insurance companies money in the short term, but they certainly result in negative medical outcomes and higher overall health care costs for the American consumer. To improve patient health and lower costs for consumers, insurers must reduce co-pays and eliminate the even more expensive and price punishing specialty tiers.
 

Most insurers today require consumers to foot part of the bill for prescription drugs. Many also enforce a tiered copayment system, where some drugs cost more than others. Drugs in a "specialty tier" are the most expensive, even though they are often the most important for a patient's health.
 

Blue Cross Blue Shield of North Carolina's specialty tier, for instance, includes drugs for cancer, arthritis, and Hepatitis C. Despite the fact that many patients require these medicines for their day-to-day life, these drugs cost patients the most.
 

Even Medicare drug plans use specialty tiers. According to the Kaiser Family Foundation, the number of Medicare drug plans that use specialty tiers nearly doubled between 2006 and 2008.
 

Some insurers are even refusing to cover new prescription drugs. According to a study from Wolter Kluwer Health, insurers' denial rate for brand-name meds was 10.8 percent at the end of 2008 -- a 21 percent jump from the year before.
 

This is bad for patients and the American health care system, as people respond to high co-pays by skipping medicines.
 

A few years ago, researchers at Oregon University studied the effects of introducing a $2 to $3 co-pay for prescription drugs among 17,000 patients. Adherence to treatment dropped by 17 percent.

Conversely, even minor reductions in out-of-pocket drug costs have dramatic effects on usage. A recent report from Milliman, a health care consulting firm, found that when the cost-sharing for an expensive chemotherapy medication was decreased from 20 percent to 19 percent, drug usage increased by 3.3 percent.
 

A recent report from the University of Pennsylvania School of Medicine supports these findings. The study looked at the copayment hikes instituted by the Department of Veterans Affairs (VA) in 2002. After these cost increases took effect, 19 percent of patients with copayments on some or all of their drugs began deviating from their prescribed drug regimen.
 

Meanwhile, the likelihood of going without medications for more than three months tripled for many VA patients.
 

As one would expect, skipping medicines has serious medical consequences. A recent study in the Journal of the American Medical Association looked at what happened when copayments were doubled on prescription drugs for patients suffering from diabetes, gastric acid disease, and asthma. The report found that the dropoff in usage -- between 17 percent and 23 percent -- was accompanied by a 17 percent increase in emergency room visits and a 10 percent increase in hospital visits.
 

Because of effects like these, increased cost-sharing on prescription drugs actually raises overall health care costs. A 2005 study showed that widespread failure to adhere to prescription drug regimens costs the U.S. health system $100 billion a year. That's not counting the additional $50 billion in lost worker productivity that results from patients not following their prescribed course of treatment.
 

Much work remains in fixing our health care system. To help lower costs and improve medical outcomes, insurers -- and lawmakers -- need to recognize the futility, indeed the danger of high co-pays and specialty tiers.