Legislation May Improve Patient Access to Vital Medications
High Out-of-Pocket Costs a Barrier to Health
ATLANTA – Cost-sharing practices that limit access to vital medications for people with serious health conditions may soon be alleviated for many patients thanks to a bill just introduced in Congress. The bi-partisan legislation, supported by the American College of Rheumatology, the Arthritis Foundation and other medical and patient groups, has been introduced by Rep. David B. McKinley (R-WV) and Rep. Lois Capps (D-Calif.).
The Patients' Access to Treatments Act of 2012 (H.R.4209) would limit co-payment, co-insurance or other cost-sharing requirements that insurance plans require for so-called "specialty" medications and make access to innovative and necessary medications more available to people with chronic, disabling or life-threatening conditions.
"Excessive cost sharing that prevents insured patients from accessing the medications they need is simply unacceptable," says Dr. James O'Dell, American College of Rheumatology president and rheumatology professor of internal medicine at the University of Nebraska Medical Center and the Omaha Veterans Affairs Medical Centers in Omaha, Neb. "We applaud the leadership of Reps. McKinley and Capps for their commitment to making sure more people can access the specialty medications that can prevent them from becoming disabled, seriously ill, or dying. Their efforts today will help to reduce unnecessary surgeries, hospital and ER visits, as well as the high costs of long-term care for people whose health conditions worsen because they are not able to receive proper treatment."
Insurance plans are increasingly adopting a tiered prescription drug system that puts the most expensive medications into a higher specialty tier. Medications placed on a specialty tier require enrollees to pay a percent of the cost as opposed to a traditional co-pay. As a result, patients' out-of-pocket costs could run from several hundred to thousands of dollars a month for a single medication. These practices are placing necessary treatments out of reach of insured Americans with chronic disease and contributing to disability and rising healthcare costs.
"High patient cost-sharing compromises access to needed medications, such as biologic therapies that have proved to reduce disability and maintain function for certain inflammatory forms of arthritis," says President and CEO of the Arthritis Foundation Dr. John H. Klippel. "While arguably the most significant treatment advancement of this era for arthritis, the costs for these medications can exceed $20,000 annually, making the drug unaffordable. As a result, people tend to delay or stop taking medications, which in turn, costs our economy millions of dollars each year in additional health care costs and lost wages."
"Millions of Americans--too many--currently suffer from chronic and disabling diseases and are unable to afford critical treatments to relieve their pain and prolong their lives," says Rep. McKinley. "Over 300,000 children nationwide suffer from juvenile arthritis alone. The Patients' Access to Treatments Act of 2012 will allow access for millions of insured Americans to these critical treatments that can save their lives, help them function in daily life, or prevent them from becoming totally disabled."
The Arthritis Foundation and the American College of Rheumatology have partnered together representing both patients and health care providers to raise awareness of the detrimental impacts of excessive cost-sharing practices that have become a barrier to improved health for people with rheumatoid arthritis, lupus, psoriasis and other chronic conditions that are impacted by these practices. The affected class of medications, known as biologic drugs, is used to prevent joint destruction and disability associated with certain forms of inflammatory arthritis. Similar medications are used to treat conditions that include multiple sclerosis, lupus, Crohn's disease, hemophilia, some forms of cancer, and other conditions.
"Too many insured Americans find that when they need it most, their prescription drug coverage falls short. As a nurse, I know full well the importance of ensuring that patients can access the treatments their doctor prescribes. The Patients' Access to Treatments Act of 2012 would provide hope for millions of Americans and their families who will no longer have to worry about how to pay for their medications and can focus, instead, on getting well," says Rep. Capps.
People concerned about lower costs for medications can take a simple step: Ask your member of Congress to sponsor the Patient's Access to Treatments Act of 2012 (H.R.4209). Reach your lawmakers through www.arthritis.org/high_costsharing.php or www.rheumatology.org/advocacy/actioncenter.asp.
About the American College of Rheumatology
Headquartered in Atlanta, Ga., the American College of Rheumatology is an international professional medical society that represents more than 8,500 rheumatologists and rheumatology health professionals. Rheumatologists are internists or pediatricians who are qualified by training and experience in the diagnosis and treatment of arthritis and other diseases of the joints, muscles and bones. Over 50 million Americans — including nearly 300,000 children — suffer from the painful, disabling and sometimes fatal effects of arthritis and rheumatic diseases. The ACR's mission is to advance rheumatology. Learn more by visiting www.rheumatology.org or follow ACR on Twitter at twitter.com/acrheum.
About the Arthritis Foundation
Striking one in every five adults and 300,000 children, arthritis is the nation's leading cause of disability. The Arthritis Foundation (www.arthritis.org) is committed to raising awareness and reducing the unacceptable impact of this serious and painful disease, which can severely damage joints and rob people of living life to its fullest. The Foundation funds life-changing research that has restored mobility in patients for more than six decades; fights for health care policies that improve the lives of the millions who live with arthritis; and partners with families to provide empowering programs and information.