Advocacy > Public Policy Priorities
Bill Would Curb Rising Co-Pays
Capping out-of-pocket prescription costs
The Affordable Access to Prescription Medications Act of 2009
(S. 1630/ H.R. 3799) introduced in the Senate by Sen. Jay Rockefeller (D-W.V.) and in the House by Rep. Hank Johnson (D-G.A.) would place "caps," or maximum payments, on individual prescriptions as well as monthly out-of-pocket costs. People living with psoriasis and psoriatic arthritis often face high out-of-pocket prescription costs even when they have health insurance. Caps would apply to prescription copayments under public (including Medicare) or private insurance.
The legislation also takes on an issue that is causing hardship for Medicare members. Ninety percent of Medicare prescription drug plans include a "specialty tier" for expensive medications, such as biologic drugs used to treat psoriatic disease, and require individuals to pay as much as 33 percent of the drug's cost. The proposed legislation would allow Medicare Part D members to ask for an exception that would lower the cost of a medically necessary specialty tier drug. This could improve access to biologic drugs.
Current insurance practices that include provisions for specialty tier drugs and high copayments prevent access to medically necessary treatments by increasing out-of-pocket expenses for individuals and businesses. Patients can't access the drugs they need and as a result, many can't lead normal lives. Without access to prescribed medications, these patients risk health complications and, sometimes, even permanent disability. The National Psoriasis Foundation commends Sen. Rockefeller and Rep. Johnson for their leadership in addressing this issue that is so critical to people with psoriasis and psoriatic arthritis and other life-threatening or chronic diseases. Read our letters of support to Senator Rockefeller and Representative Johnson (PDF) and send your elected officials a message!
Allowing copayment assistance from the manufacturer of the drug
Senator Kent Conrad (D-N.D.) and Senator Maria Cantwell (D-Wash.) offered amendments during the process of developing new federal health care legislation which would improve access to care for individuals with Medicare Part D coverage. The proposal would allow copayment assistance from manufacturers similar to the assistance these companies provide to private insurance members.
Currently, people with prescription drug coverage through Medicare Part D are not eligible to receive assistance from the manufacturer with out-of-pocket costs for their medication. While people with private health coverage can participate in copay assistance programs, those with Medicare Part D are excluded by federal law and must apply to private foundations. For Medicare members with high medication costs, the coverage gap (also known as the "doughnut hole") quickly becomes a problem. During this time, Medicare members are responsible for the full cost of their prescription drugs, as much as $1,700 a month. In one year, the out-of-pocket costs can exceed $4,500, a catastrophic amount for individuals with limited resources. Although the law passed in March 2010 gradually reduces and eliminates the doughnut hole, Medicare patients will still be required to pay for 25 percent of the cost of their medications, up until "catastrophic coverage" kicks in at $4350.
Although the proposed amendments were not included in the final health care law the Senate may address this issue in the future. Allowing manufacturer copay assistance for Medicare members would greatly ease the financial burden on Medicare members with psoriasis and psoriatic arthritis who rely on medications to maintain their daily activities and quality of life. Read our letters of support for the amendments.
Do you have trouble affording your biologic medication due to problems with Medicare Part D? Ask your Representative in Congress to co-sponsor H.R. 3799, the Affordable Access to Prescription Medications Act of 2009. Over 500 members of the Psoriasis Action Network have already asked 270 members of Congress to co-sponsor this legislation!