Increased cost-sharing requirements are putting breakthrough treatments out of reach for many patients. Each year patients are subjected to a higher percentage of the total cost of care. In the last decade, premiums for those with employer coverage increased 89% and the percentage with deductibles greater than $1,000 nearly tripled. Insurers also are adding more specialty tiers to their pharmacy benefit designs: between 2012 and 2013, use of specialty tiers increased 65% among private plans. Making this problem even worse is the growing prevalence of high deductibles.
When patients can’t afford their treatment, the consequences can be serious. Increases in out-of-pocket cost have been shown to lower medication adherence, increase non-pharmacy costs, and lead to worse health outcomes. On average, a $10 increase in copays yields a 4% increase in medication nonadherence, a problem estimated to cost the United States $290 billion annually. As a result of high-cost sharing, patients may not use their medications appropriately, skipping doses in order to save money or abandoning a treatment altogether. According to several studies, prescription abandonment rates increase significantly when patient cost sharing exceeds $100.
Our position: Support
U.S. Pain Foundation supports out-of-pocket caps that protect people with chronic conditions who are subjected to excessive cost-sharing requirements. Read our full position statement here.
When patients can’t afford their treatment, the consequences can be serious.
Examples of U.S. Pain’s efforts
- Patient groups come together to weigh in on HHS prescription costs plan
- CT law to end prohibition on pharmacists sharing cost-saving information
- “State efforts to reduce consumers cost-sharing for prescription drugs” – Commonwealth Fund
- “What are the recent and forecasted trends in prescription drug spending?” – Kaiser Foundation
- “Specialty Tier Pharmacy Benefit Designs in Commercial Insurance Policies: Issues and Considerations” – Georgetown Health Policy Institute
“How do deductibles, copays and coinsurance work?” – Blue Cross Blue Shield