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High out-of-pocket costs

The issue

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.

The problem

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

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