The Immune Deficiency Foundation (IDF) is advocating for legislation to limit patient costs for lifesaving medication. The Patients’ Access to Treatments Act, H.R. 460, seeks to restrain high out-of-pocket costs for specialty medications like immunoglobulin (Ig) therapy, an essential treatment for many patients with primary immunodeficiency diseases (PI).
Introduced by Rep. David McKinley (R-WV) and Rep. Lois Capps (D-CA), this bipartisan legislation will help ensure patients, with chronic, disabling and life threatening conditions to access to the treatments they need. It would limit out-of-pocket costs for medications in a specialty drug tier (typically Tier IV or higher) to the dollar amount applicable to the drugs in a non-preferred brand drug tier, making it easier for patients to afford their needed mediations.
More about Specialty Tiers
Traditionally, commercial health insurers have charged flat co-payment fees for different tiers of medications: generics (Tier I), preferred name brand medications (Tier II), and non-preferred brand medications (Tier III). As an example, the co-pays might be set at $10/$20/$50 for the three tiers. Some commercial health insurance policies are now moving vital medications, mostly biologics such as Ig which many patients with PI rely on, into “specialty tiers” that utilize high patient cost-sharing methods.
These specialty tiers are now commonly requiring patients to pay a percentage of the actual cost of these drugs – from 25% to 40% or more – often costing hundreds, even thousands, of dollars per month for a single medication. These practices are placing medically necessary treatments out of reach for average Americans.
Biologic medicines, such as Ig, have no generic or inexpensive equivalents. In addition to patients with PI, affected patients include certain types of cancer like leukemia and lymphoma, multiple sclerosis, rheumatoid arthritis, psoriatic arthritis, lupus, hemophilia, Crohn’s disease, and other conditions. Some of these patients currently endanger their health by skipping doses or go without treatment altogether due to excessively high cost-sharing.
If you or someone you know is facing a high specialty tier co-insurance for Ig therapy, please contact IDF immediately. Call 800-296-4433 or submit our online form:www.primaryimmune.org/services/ask-idf.