As an adult with psoriatic arthritis and as a mother with a child who has juvenile psoriatic arthritis, our family will see quite a financial burden in the near future trying to afford our special medication, Humira.
Many insurance plans have instituted a tiered payment system for medications. Often labeled "generic," "preferred," and "non-preferred," these tiers have a set cost-sharing amount. But there is also a fourth tier, called "specialty tiers," that requires patients to share a significant amount of the cost of expensive medications.
Biologic medications, including those used to treat psoriasis and arthritis, are increasingly found in this fourth tier. This results in high out-of-pocket costs that can reach into the thousands just for one medication for one month.
In a few short months, I will be faced with this reality myself. My current copay with prescription coverage will increase to approximately $300 per month for Humira. Eight years ago, the copay was a fixed rate of $60. Because this medication has allowed me to lead a more normal life and have significantly less pain, fatigue, swelling in my joints and has been the only medication found to reduce my red, itchy, painful psoriasis plaques, it is important that I continue this medication. Discontinuing this medication will also likely increase joint damage that cannot be reversed.
If this practice of specialty tiered copays continues, I will be forced to choose between my health and paying all of our family bills. And in less than four years, this copay will double each month. The reason is because my son, who has juvenile psoriatic arthritis and is also on Humira, will no longer be eligible for Michigan's Children Special Health Care, a part of Medicaid that helps families cope with medical costs for children with chronic diseases. He will be 18 years old and too old to participate in this plan.
There are no generic alternatives to biologics at this time, but there is legislation in Congress that will help families afford their medications and not have to choose between good health and paying the bills. We urge all of our state representatives in Washington D.C. to support HR 460, The Patients' Access to Treatment Act.