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.
President Biden has repeatedly promised to make health care more affordable. And his administration has taken some important steps. But sadly, officials at the Centers for Medicare and Medicaid Services just passed up an opportunity to save patients millions at the pharmacy.
Over the next few weeks, thousands will select insurance plans for 2022, whether on a state exchange or through their employer. 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, or financial help that drug companies offer to patients to assist them with prescription drug out-of-pocket costs. [This opinion piece also appeared in The Lebanon Democrat, The Leader/Observer, Forest Hills/Rego Park Times, Long Island City/Astoria/Jackson Heights Journal, Greenpoint Star, and Brooklyn Downtown Star.]
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.