Photo by Allison V. Smith

Rose Garcia’s doctor prescribed six drugs to coincide with her chemotherapy treatment. But when her husband went to pick up the medications, he faced sticker shock. The price tag for one month’s supply was $1,500. And that was after the pharmacy processed the order with Garcia’s health insurer, Blue Cross Blue Shield of Texas.

Garcia, 45, of Irving, Texas, was confused. Her insurance card lists prescription copayment amounts of $20, $35 and $50, but each drug that she needed cost hundreds of dollars.

Garcia is not alone. Many insurance providers, including Medicare, are trying a new tack these days to keep costs down: They’re charging a percentage of the total cost of certain expensive drugs—a dramatic departure from the insured paying a fixed and more affordable copay for their prescriptions.

“As more and more drugs enter the market that cost $500 to $1,000 a month, this is a way for them to contain costs,” says Stacey Swartz, senior director of pharmacy affairs at the National Community Pharmacists Association.

In most cases the drugs that fall into this category, known as Tier 4 drugs, treat illnesses like cancer or chronic diseases such as hemophilia or HIV/AIDS, which affect a relatively small group of people but are expensive to research. However, Swartz says, she has seen some drugs for more common conditions like osteoporosis enter this category.

As for Garcia, she was forced to ask her mother, brothers and son to pitch in on that first round of medication. Then she and her husband cut household costs to be able to afford the remainder of her six-month drug regimen. “It’s a strain, but you know, I need it, so I can do without other things,” Garcia says.