(PRNewswire-USNewswire) 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.).
ThePatients' 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.
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.
While arguably the most significant treatment advancement of this era is 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, can increase healthcare costs.
The Arthritis Foundation and the American College of Rheumatology have partnered together representing both patients and healthcare 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.