Year after year, we hear that rising medical costs are being borne by family, friends, and neighbors. The cost of life-saving drugs continues to tax the pocketbooks of so many families.
Specialty medicine has come a long way. This allows these same individuals to live longer and healthier lives. Approved new treatments to help treat the underlying cause.
But the prices of specialty medicines used to treat cancer, diabetes, multiple sclerosis, cystic fibrosis and other complex chronic diseases continue to rise, putting patients in a difficult position. . health.
We deserve better solutions. Too many patients are injured and there are ways to fix it.
Until recently, there were some solutions for those affected. Pharmaceutical companies and nonprofits helped patients and families with out-of-pocket assistance savings programs. This has allowed me to reduce my out-of-pocket costs for medication and treatment. Savings provided by the program are intended to be applied to a patient’s insurance deductible, helping patients reach their out-of-pocket limit and have their insurance cover the remaining costs.
But in 2018, insurers and pharmacy benefit managers (PBMs) decided that people could save lives by classifying new treatments as “non-essential,” even though there are no common options available. I discovered a loophole in the law aimed at making drugs accessible.
Insurers are not required to account for funds provided by third parties as “non-essential drugs to customers.” You should change this.
They are happy to accept money from assistance programs, but force patients to pay thousands more for the medicines they need to reach their out-of-pocket limits.
This latest scheme is getting a lot of attention. This is because most people affected do not know that their health plan has a copay accumulator or maximizer program. meet the deductible). It’s a terrifying prospect, and the inability to continue using the best treatments modern medicine has discovered to treat or manage their disease is even worse.
In 2021, a bill to close the loopholes in Michigan (HB 4353) passed the state legislature with broad bipartisan support, but was defeated in the Senate. The new Congress passed legislation to prohibit insurance companies and her PBM from continuing this harmful practice and to give patients the freedom to access and purchase the life-saving drugs they need to manage their chronic illnesses. Have a chance to update.
Additionally, legislation introduced in Congress with bipartisan support: HR 5801, Helping Patients Reduce Their Burden (HELP) Copays Act amends the Public Health Services Act to address health insurance cost-sharing requirements. to apply for additional payments, discounts, and other financial assistance. Planning, and Other Purposes.
Now is the time to help patients and their families buy the medicines they need. Lawmakers must protect patients, do what is right, and hold insurance companies and her PBMS accountable.
David Woodward is chairman of the Oakland County Commission.
