Ann: Ryoncil Pricing Set and Available This Quarter, page-528

Co-pay, Co-insurance and deductibles are all forms of cost sharing between insurance companies and patients. Also involved are maximum out of pocket expenses, which are designed to limit how much one person or their responsible party can possibly pay in a given year.

Co-Pay is usually a dollar amount (a very small amount like $100) that each person pays when getting care.

Co-insurance is usually a percent that each person pays, and is usually only applied to larger expensive care.

A deductible is usually the amount, say $2000 that a person must pay before insurance kicks in for certain care.

Co-pay and Co-insurance are both charged against a maximum out of pocket expenses. Once a patient has reached this level, insurance covers 100% of the charge.

One of the key purposes for the MyMesoblast portal established by the company is to help patients access care when the out of pocket expenses are high. The company (directly or through their representatives) would pay for all or part of the out of pocket expenses, and the insurance company would pay the rest. These systems are designed to ensure access to treatments, while not denying care to those who would be turned off by the out of pocket expenses.

Again, it is helpful to consider that a patient who needs Ryoncil would have received a bone marrow transplant. Such a procedure would likely have caused them to use up their entire Co-insurance and likely exceeded their out of pocket maximums for the year. There's of course a small chance that the transplant takes place in one year, and the need for Ryoncil is in the next year.

I know to foreigners the US healthcare system is complicated. It is. There are sometimes too many players taking a cut and adding little value. The majority of players has an incentive to make profits. The good thing is the system is designed to keep people alive. So while there are companies who may deny use of a treatment, the cost is hardly a hurdle for patients or for the insurance companies.