Dear Representatives Ann Kirkpatrick, Ron Barber, Raul Grijalva, Paul Gosar, Matt Salmon, David Schweikert, Ed Pastor, Trent Franks and Krysten Sinema:

Children with Juvenile Arthritis from all over the state of Arizona wanted to share their opinion on arthritis with their legislators. Join the Arthritis Foundation in supporting HR 460!

 

 Issue Brief: H.R. 460: The Patients’ Access to Treatments Act

Background

Traditionally, commercial health insurers have 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.

Some commercial health insurance policies are now moving vital medications (mostly biologics) into "specialty tiers" that utilize high patient cost-sharing methods. This "fourth tier (IV)" is now commonly requiring patients to pay a percentage of the actual cost of these drugs – from 25% to 50%, often costing hundreds of dollars, even thousands of dollars, per month for a single medication – rather than a fixed, flat dollar co-payment. These practices are placing medically necessary treatments out of reach of average Americans.

With appropriate treatment in patients with chronic, life-threatening and disabling conditions including rheumatoid arthritis, MS, lupus, hemophilia, and some forms of cancer, biologic drugs can prevent patients from becoming disabled, seriously ill, or even dying.

Biologics are FDA approved and have no inexpensive generic equivalents.

Individuals unable to afford specialty tier pricing are likely to go without crucial medications, resulting in disability and other future expensive health complications.

Monthly co-pays/co-insurance amounts can range from $500-$5,000 or more. Cost-sharing for prescription medications should not be so large as to restrict and interfere with medically necessary use of medications.

Solution

The bipartisan Patients’ Access to Treatments Act of 2013 (H.R. 460), 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).

Please co-sponsor this legislation by contacting Rep. David McKinley’s office at devon.seibert@mail.house.gov or x54172.

This legislation is also currently supported by the American College of Rheumatology, American Academy of Neurology, American Academy of Pediatrics, American Autoimmune Related Diseases Association, American Society of Clinical Oncology, COPD Foundation, Crohn's and Colitis Foundation of America, Colon Cancer Alliance, Hemophilia Federation of America, Immune Deficiency Foundation, Leukemia and Lymphoma Society, Lupus Foundation of America, National Hemophilia Foundation, National Psoriasis Foundation, Patient Services Incorporated, and the Spondylitis Association of America.

For more information on HR. 460 and how to become an Arthritis Advocate in Arizona, please visit www.arthritis.org/advocacy or contact Allie Avishai at 602-212-9905 or aavishai@arthritis.org

 

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