Pass the Patients' Access to Treatments Act
Drugs Are Being Placed Out of Patient Reach
Some commercial health insurance policies are now moving vital medications (mostly biologics) into specialty tiers. Specialty Tiers require patients to pay a percentage of their drug cost– from 25% to 50%– rather than a fixed co-payment. These practices are placing medically necessary treatments out of reach of average Americans. This can make medically-necessary drugs unattainable for the average insured American, which can lead to:
- Worse health outcomes
- Higher rates of disability
- Higher health care costs over time
Commercial health insurers have traditionally charged fixed co-pays for different tiers of medications. As an example, the co-pays might be set at $10/$20/$50 for the three tiers.
How Does This Affect People With Arthritis?
Those with rheumatoid arthritis (RA) are typically charged 25-50% of the cost of their drugs. However, RA medications can cost up to $4,000 a month. This translates to $1,000-$2,000 a month in patient costs.
- Biologics are FDA approved and have no inexpensive, generic equivalents.
- Biologics can prevent patients with rheumatoid arthritis, MS, lupus, hemophilia, and some forms of cancer, from becoming disabled, seriously ill, or even dying.
- Monthly co-insurance amounts can cost thousands of dollars. Cost-sharing for prescription medications restricts access to medically necessary drugs.
- Individuals unable to afford specialty tier pricing are likely to go without crucial medications, resulting in disability and other expensive health complications.
This is why Congress needs to pass the Patient's Access to Treatments Act.
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The bipartisan Patients’ Access to Treatments Act (H.R. 1600), introduced by Rep. David McKinley (R-WV) and Rep. Lois Capps (D-CA), limits cost-sharing requirements in the specialty drug tier (typically Tier IV or higher) to a similar dollar amount applicable to drugs in a non-preferred brand drug tier (typically Tier III).