In Reply We appreciate the thoughtful comments of Grube and Cardenas in response to our recent article.1
We agree with the observation that many commercial insurance plans do cover the cost of secobarbital for use in aid-in-dying. Of the 35 patients at our center participating in the Death With Dignity program who were prescribed secobarbital between 2010 and 2016, 12 patients (34%), all of whom had commercial insurance, received some degree of coverage for this medication. Copayments for these 12 patients ranged from $2.00 to $1236.26. The remaining 23 patients (66%) either chose to pay cash for the medication or were insured through a federally funded plan (including 7 Medicare beneficiaries, 2 federal employees, 1 Tri-Care enrollee, and 1 Community Health Plan of Washington enrollee) that did not cover any portion of the secobarbital cost.
Shankaran V, LaFrance RJ, Ramsey SD. Insurance Coverage and Aid-in-Dying Medication Costs—Reply. JAMA Oncol. Published online May 25, 2017. doi:10.1001/jamaoncol.2017.0406