WASHINGTON – The Arthritis Foundation supports new bipartisan legislation introduced in the House of Representatives this week that will counteract an alarming trend in today’s health insurance market: moving vital medications into specialty tiers where patients share a high percentage of the costs. If passed, the Patients’ Access to Treatments Act (PATA) of 2015, introduced by Reps. David B. McKinley (R-WV) and Lois Capps (D-CA), will limit cost-sharing requirements for medications placed in a specialty tier and make innovative and necessary medications more accessible by reducing excessive out-of-pocket expenses.
Specialty tiers commonly require patients to pay a percentage of the cost of the drug (co-insurance), which can range from 25 to 50 percent or higher, resulting in hundreds – and even thousands – of dollars per month in out-of-pocket costs.
In addition, new and innovative medications coming to market often fall into these tiers. For people with arthritis, many of these new medications are biologics – a true innovation for people with autoimmune forms of the disease, like rheumatoid arthritis (RA). These complex medications, made from living organisms, use the body’s immune system to fight the condition, and in some cases even halt its progression.
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