Arthritis Foundation Supports Legislation to Ensure Access to Innovative Treatments

Patients’ Access to Treatments Act would end specialty tier cost sharing and provide relief for more than 50 million with arthritis

WASHINGTON – The Arthritis Foundation supports new bipartisan legislation introduced in the House of Representatives this week that will counteract an alarming trend in today’s health insurance market: moving vital medications into specialty tiers where patients share a high percentage of the costs.  If passed, the Patients’ Access to Treatments Act (PATA) of 2015, introduced by Reps. David B. McKinley (R-WV) and Lois Capps (D-CA), will limit cost-sharing requirements for medications placed in a specialty tier and make innovative and necessary medications more accessible by reducing excessive out-of-pocket expenses.

Specialty tiers commonly require patients to pay a percentage of the cost of the drug (co-insurance), which can range from 25 to 50 percent or higher, resulting in hundreds – and even thousands – of dollars per month in out-of-pocket costs. 

In addition, new and innovative medications coming to market often fall into these tiers.  For people with arthritis, many of these new medications are biologics – a true innovation for people with autoimmune forms of the disease, like rheumatoid arthritis (RA).  These complex medications, made from living organisms, use the body’s immune system to fight the condition, and in some cases even halt its progression.

“A patient’s financial responsibility, or cost sharing, for a prescription medication should not be so large that it inappropriately restricts or interferes with medically-necessary use of medications,” says Ann Palmer, president and CEO of the Arthritis Foundation. “ PATA would rein in high cost sharing for specialty medications, enabling more patients with chronic, disabling and life-threatening conditions, such as arthritis, to access and afford the treatments they need.” 

For some arthritis patients, the cost-sharing responsibility for prescription drugs can total more than $1,500 a month, putting their access to drugs at risk. Studies show that the higher the out-of-pocket costs, the less likely patients are to take their medications on time, if at all. Failure to adhere to a treatment plan because of lack of access to medications can lead to worsening disease, increased rates of disability, rising health care costs and the loss of function, productivity and independence. 

The Arthritis Foundation is one of 32 members of the Coalition for Accessible Treatments, which encourages patients and physicians to ask lawmakers to support and co-sponsor the Patients’ Access to Treatments Act of 2015.

About the Arthritis Foundation:

The Arthritis Foundation (www.arthritis.org) is the largest and most trusted nonprofit organization dedicated to addressing the needs and challenges of those living with arthritis, the nation’s leading cause of disability. Since 1948, the Foundation has remained committed to leading groundbreaking research for better treatments and a cure; fighting for patients’ access to affordable and effective health care; and providing trusted information and resources to the more than 50 million adults and 300,000 children living with the disease.