Lawmakers should ban insurance language that makes essential drugs unaffordable – California Health Report

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When a patient comes to me with a problem or illness that can be treated or even cured, my priority as a doctor is to ensure they are receiving the correct and most effective treatment or medication. Unfortunately, I’m often forced to include another consideration in my prescription: a patient’s ability to afford the drug.

The most effective drug is the one my patients have access to and can afford. What is the use of prescribing if patients cannot afford to fulfill the prescription or are forced to ration it? Being able to afford ongoing medication is life-saving for patients with a chronic illness.

It is incredible to see the new discoveries and advances in medicine in recent years that are enabling us to treat and manage formerly uncontrollable, incurable or even fatal chronic diseases. In recent years there have been over two dozen new FDA-approved cancer treatments; new devices for monitoring and administering insulin to diabetic patients; and even a new therapy for people with cystic fibrosis that could add decades to a patient’s life expectancy. Unfortunately, insurers don’t want to foot the bill for the high costs of these newer treatments, so they’ve added “copay accumulator” language to health plans to pass more of the cost on to patients, which in turn forces patients to choose for or against to decide to prioritize their health or other basic needs.

Plans that include a co-payment accumulator prohibit patients from applying financial assistance received for prescriptions to their deductible or co-payment. Why is that important? For years, nonprofits and pharmaceutical manufacturers have attempted to bridge the gap between high prescription prices and what patients can afford by creating copay utility programs that provide coupons and vouchers to reduce or eliminate patient out-of-pocket expenses. These financial assistance programs still exist — and patients still try to take advantage of them — but the assistance goes straight into insurers’ pockets rather than helping patients.

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This exposes chronically ill patients to costly ongoing fees for their prescription medications, in addition to the cost of other healthcare services they (or their families) may need throughout the year. As a result, many patients could be forced to leave without their medication. Nationwide, 20 to 30 percent of medications go unfilled and about 50 percent of chronic disease medications are not taken as prescribed. The Annals of Internal Medicine estimates that this decline in medical adherence is responsible for approximately 125,000 deaths nationwide. It can not go on like this.

The California Legislature has a distinguished history of passing laws that make a significant difference in the lives of those who live in the state. I urge members of the California Legislature to approve AB-874 by Member of Parliament Dr. Supporting Akilah Weber, which would end this unscrupulous scheme and allow funds from Copay assistance programs to count against an insurer’s maximum or deductible. The health and well-being of our patients and communities should not be subject to arbitrary decisions by insurance companies.

dr Sion Roy is a member of the Santa Monica College Board of Trustees, a cardiologist and past president of the LA County Medical Association.

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