A Call To Policymakers For Lower Out-of-Pocket Costs


Policymakers Must Offer Solutions That Provide Patients with Lower Out-of-Pocket Costs For Critical Medicine

In addition to coping with chronic illness, many patients are faced with the challenge of trying to afford life-saving medication.

The Catalyst recently highlighted an article featuring the urgent need to fix a “broken insurance system” that is failing people who are most in need of care.

Patients with diabetes, asthma, cancer, and HIV among other diseases are facing extremely high out-of-pocket costs. In many cases due to the way our insurance system is designed, these patients are unable to purchase their medication.

The insurers have not directed the cost savings to patients nor have they applied cost-sharing where it belongs – with the patients.

Biopharmaceutical companies in the states claim that they want to be part of the solution.

Looking at the bottom line, when patients stop purchasing their medication and their illness takes over, it overwhelms the system.

2019 statistics demonstrate the disparity between patients with fixed copays and patients who are taking brand name medicine. They must pay coinsurance and deductibles. On average they pay:

  • Twenty-five times more for cancer medicines
  • Ten times more for their HIV medicine
  • Three times more for their diabetes and asthma medicine

For example, thirty-four percent of patients forego their newly prescribed HIV medication when their costs exceed $250. This only results in more serious health problems and even more costs throughout the broader healthcare system.

It is evident that companies are moving the cost of medicine over to patients who have chronic illnesses. These patients are not only dealing with the burden of their illness but are forced to make decisions as to whether they will continue to take their prohibitively expensive drugs.

The Big Picture

Biopharmaceutical companies have negotiated discounts and rebates. Those cost savings are benefiting insurance companies and benefit managers (middlemen) on brand medicine instead of being passed on to patients at their pharmacies.

Digging deeper, we shine a light on policy changes that apply to commercial health plans and Medicaid. These changes have now affected biopharmaceutical manufacturers by making it more difficult to benefit patients who are commercially insured.

It is up to the policymakers to find the solution, especially in this economic climate. They must ensure that these substantial discounts and rebates that are negotiated with manufacturers are actually filtered down to the patients. Policymakers must transfer cost-sharing to out-of-pocket expenses.

On a somewhat encouraging note, there are a few biopharmaceutical companies that provide a cost-sharing lifeline to patients. This applies to some medical expenses for commercially insured patients.

And there should be no excuses if biopharmaceutical companies are supposed to be standing ready to participate in a holistic solution. A solution that is directed at affordable medicines for the people who desperately need them.

Rose Duesterwald

Rose Duesterwald

Rose became acquainted with Patient Worthy after her husband was diagnosed with Acute Myeloid Leukemia four years ago. He was treated with a methylating agent While he was being treated with a hypomethylating agent, Rose researched investigational drugs being developed to treat relapsed/refractory AML.

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