Aug 07, 2009
New Bill Submitted In The Senate To Reduce And Cap Soaring Out-Of-Pocket Drug Costs
Bill Provides Needed Provisions for Affordable Medicines with Potential to Save People with MS
Up to $6,600 on Their Disease-Modifying Therapies
Today national health care reform took a step closer to ensuring access to affordable medicines when Senator John D. Rockefeller IV (WV) introduced the Affordable Access to Prescription Medications Act of 2009. This legislation would cap monthly out-of-pocket costs for medications – including drugs under Medicare Part D as well as those in the private insurance market.
A growing number of insurers are moving vital medications onto specialty tiers, effectively pricing those treatments out of reach for many. That can adversely affect patients with multiple sclerosis and other conditions (such as arthritis, cancer, and psoriasis), who rely on these more costly drugs with no generic alternatives for their well being or survival. While the patient typically pays an increasing but fixed amount for medications on the first three tiers of a formulary, the fourth tier, or specialty tier, imposes a co-insurance or percentage (20-35 percent or more) of the cost of the drug. Individuals who need those medicines most are least able to afford them.
The Affordable Access to Prescription Medications Act would help control this cost-sharing system and create a monthly $200 per medication cap on all out-of-pocket prescription drug costs, and a monthly $500 per person cap for those taking more than one medication. Many health care reform proposals seek to cap yearly out-of-pocket drug costs, but this legislation takes it one step further by capping monthly out-of-pocket drugs costs. It will improve access to care and make important medications more affordable to those who need them most.
“The National Multiple Sclerosis Society is grateful to Senator Rockefeller for his leadership in supporting caps on monthly out-of-pocket costs for prescription medicines, including MS disease-modifying therapies that can cost more than $30,000 per year,” Joyce Nelson, president and CEO of the National MS Society, said. “This bill would provide peace of mind for thousands of Americans by helping to ensure access and limit prohibitive costs for people living with chronic disease like MS. It is an essential addition to any health care reform.”
MS is a chronic, often disabling disease of the central nervous system. The cause is unknown and there is no cure. Early and ongoing treatment can slow the disease progression, and it can reduce the frequency and intensity of flare-ups. MS disease-modifying therapies allow for more active, productive lives and less reliance on our health care system. But those drugs can exceed $30,000 per year or more than $800 per month in out-of-pocket costs.
A recent survey showed that more than 20% of people living with MS could not fill their prescriptions, skipped medication doses, or split dosage without their doctor’s consent because they did not have adequate coverage or access. These facts are not acceptable and are the reasons that the Society is pushing hard to make sure that health care reform addresses the needs of people living with MS and other chronic diseases.
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