The heavy toll arthritis takes is unacceptable. Many of the 50 million adults and 300,000 children with arthritis experience limitations and disruptions to their lives because of pain and disability. People with arthritis, and others with chronic, disabling and life-threatening conditions, depend on medications to treat their disease and reduce symptoms. Expensive prescription drugs place a financial burden on people, causing them to struggle financially or to go undiagnosed or untreated because they can’t afford their medication.

The Heavy Financial Toll of Arthritis is Unacceptable

Because of increasing costs, many insurance plans, including Medicare Part D, that cover prescription drugs have instituted a tiered payment system for medications. The tiers are often labeled ‘generic,’ ‘preferred,’ and ‘non-preferred’ and each have a set cost-sharing amount. A fourth tier, known as “specialty tiers”, utilizes high patient cost-sharing for certain expensive medications. Instead of paying a fixed amount for medications, patients who receive specialty tier medications pay a percentage of the cost of the drug, resulting in skyrocketing costs for a single medication. Biologic medications, including arthritis disease-modifying therapies, are increasingly found in specialty tiers. This results is high out-of-pocket costs, ranging from hundreds of dollars a month for a single medication to the thousands. Because of this financial burden, people with arthritis may stop taking their prescribed medication or skip doses because they simply cannot afford it - even though they have health insurance and a prescription drug plan. Because there are no generic alternatives to biologics, the specialty tier cost-sharing structure negatively impacts people that depend on biologics - people with rheumatoid arthritis, psoriatic arthritis and other forms of inflammatory arthritis. This practice is unacceptable and discriminates against patients with chronic conditions. Cost-sharing for prescription medications should not be so large as to restrict or interfere with people’s treatment, which can lead to negative health outcomes and additional costs to the healthcare system.

What You Can Do To Take Action on This Issue:

• Watch a video featuring Amy Melnick, Vice President of Advocacy at the Arthritis Foundation, as she discusses the burden of paying for expensive prescription drugs
• Spread the word by sharing this issue brief with your family, friends and community members.
• Read an Editorial written by Dr. Klippel, Arthritis Foundation President and CEO
• Read the Arthritis Foundation's position statement on specialty tiers
• Take a quick survey to tell us how the cost of prescription drugs has made it difficult for you to afford treatment.
• Read our press release on H.R. 460 - The Patients' Access to Treatments Act