Among Americans who take prescription drugs, a quarter struggle to afford their medication. For those who are in poor health or have low incomes, the portion is even higher. These days, the rising cost of everyday goods and services is forcing more people to face difficult decisions and ask themselves: How can I pay for utilities, the groceries, or the medicine that’s keeping me alive? Now imagine that someone offers you financial assistance for the express purpose of paying for your medicine—problem apparently solved. But in a cruel twist, your health insurer pockets that assistance, without counting it toward your annual deductible or out-of-pocket maximum. That’s why the HIV+Hepatitis Policy Institute, the Diabetes Leadership Council, and the Diabetes Patient Advocacy Coalition filed suit in federal court, challenging the Trump-era federal government rule that allows insurers and pharmacy benefit managers to carry out this harmful practice.
The silent tragedy of the COVID-19 pandemic is its devastating impact on people with other health conditions. For those illnesses, declining attention has persisted even as the threat of COVID-19 is declining. HIV provides a striking example of the setback — and how the effects are looming in the shadows. In December, President Biden set a goal of reducing new HIV infections to just 3,000 a year by 2030, a decline of more than 90 percent from current levels. That goal is achievable as long as Congress and the administration are putting the right policies in place and people can access and afford their medications.
We must make drugs more affordable: Patients going without meds can hike costs for the entire health care system
Falling ill in America is becoming increasingly unaffordable in a health care system that punishes the patient. Insurance companies and middlemen have taken away protections against health care discrimination and crushing out of pocket costs for people with complex and chronic conditions. Not only does this increase costs across the health care system, it also deters efforts to improve health equity and patient outcomes.
A health plan’s fine print hardly makes for riveting reading. So most folks just focus on the monthly premium, make sure their doctor is covered, and ensure cost-sharing responsibilities are manageable. But that fine print is important, especially when it comes to how insurers treat co-pay assistance — financial help that drug companies offer to patients to assist them with prescription drug out-of-pocket costs. Choosing a plan that doesn’t count co-pay assistance toward the deductible or out-of-pocket maximum could cost a person or family several thousand dollars per year in unexpected costs.
There’s no question that our healthcare system is broken. Where there is disagreement is in how to fix it. Current proposals being considered by the Congress do little to address the out-of-pocket spending requirements and insurance company access restrictions that impose the biggest burdens on patients. Failing to address these issues would be a huge missed opportunity.