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National Patient Advocate Foundation's Annual Capitol Hill Briefing Focuses on Patient Access Barriers to Life-Saving Medicines Placed on Specialty Tiers by Commercial Insurance Plans and Medicare
Date:5/8/2013

appeared in the Journal of Managed Care Pharmacy found that oncology patients taking prescription medications with an out-of-pocket cost higher than $200 were at least three times more likely to choose not to fill their prescriptions as those with out-of-pocket costs of $100 or less.

Congressman David McKinley (R-WV), whose office was represented at the briefing, has put forth legislation to mitigate the numerous problems specialty tier drugs pose to patients. The Patient Access to Treatments Act (H.R. 460), co-sponsored by Representative Lois Capps (D-CA) and a bipartisan list of 38 other Members, aims to give millions of patients access to critical treatments that are currently out of their financial reach. Under this legislation, commercial insurers could not charge patients a percentage of the drug cost, but rather the same fixed co-payment they charge for other medications.

"A diagnosis of a debilitating disease is enough stress for patients and their families," McKinley stated. "Cutting-edge drug therapies should be made accessible to all patients regardless of their financial situation. The right to treatment and the highest quality of life possible while ill is not just for the wealthy."

NPAF has also developed a three-pronged strategy to combat the high out-of-pocket costs of specialty tiers. NPAF is working closely with Representative McKinley's office to increase awareness to H.R. 460 and with Senate staff to explore specialty tier solutions in Medicare. NPAF is also working with the Centers for Medicare and Medicaid Services to examine regulatory solutions to specialty tiers. Furthermore, NPAF is collaborating with the health insurance industry to create an open dialogue on solutions and agreements on specialty tiers outside the legislative and regulatory scope. By doing so, NPAF aims to understand the impact changes to health plan cost sharing would have on all
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SOURCE National Patient Advocate Foundation
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