Our State Legislative Priorities
More than 2.7million people in Pennsylvania, including 11,500 children, live with arthritis. Contrary to popular belief, arthritis is not just a disease of old age. Two-thirds of people with arthritis are under age 65. Arthritis is the leading cause of disability in the U.S. costing our economy $128 billion annually in treatment and lost wages, and it is the most costly condition treated in U.S. hospitals and billed to private insurance. With our network of volunteers and dedicated staff, we are working to change laws and make health care more accessible and affordable for people and their families who are living with the disease.
On the state level, the Arthritis Foundation focuses on these legislative issues:
Prescription Drug Affordability
In response to increasing healthcare costs, insurance plans that cover prescription drugs have instituted a tiered payment system for medications. The tiers are often labeled ‘generic,’ ‘preferred,’ and ‘non-preferred’ and each has a set cost-sharing amount. In commercial private plans, cost-sharing generally varies from 20-50%. In the Medicare Part D program, cost sharing can be anywhere from 25-33% of the actual cost of the medication. These amounts can range from several hundred dollars a month for a single medication to thousands. This practice is overly burdensome and often discriminates against patients with chronic conditions. Learn more about out-of-pocket costs.
For people with arthritis who need biologic therapies to control their disease yet struggle to afford these therapies, biosimilars may hold the key to improving access to safe, effective and less expensive treatments.
Patient safety must be the number one priority in any discussion of the introduction of biosimilars to the market. Even if a drug is less expensive and more accessible than a brand name alternative, these advantages are meaningless if the drug does not successfully treat the patient – or worse, harms the patient. Physicians and patients should have access to FDA-approved interchangeable biosimilars and non-interchangeable biosimilars. Learn more about biosimilars.
Step therapy is a practice that insurers sometimes use to control costs by requiring people with arthritis to fail on less expensive prescription medications before receiving more expensive medications.
Those stable on a therapy should not be required to switch to a preferred drug and fail before accessing a therapy that meets established criteria for disease control. The choice of an individual agent is complex and is undertaken with many variables in mind, including the diagnosis, the proximity of the patient to the physician’s office, the patient’s preference for mode of administration, the patient’s mobility and the physician’s decision. Learn more about step therapy.
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