In response to increases in health care costs, insurance plans, especially self-insured plans, began shifting more of those costs to patients through higher deductibles, higher coinsurance, and placing specialty drugs on higher cost sharing tiers. In response to these cost shifting trends, pharmaceutical manufacturers and nonprofits began to offer patient assistance programs for many life-saving specialty medications that lack generic equivalents. Insurance providers countered by not allowing these patient assistance programs to count to insurance out-of-pocket maximums.
Patient assistance programs have positive benefits for patients (improves access, affordability, and compliance). However, an increasing number of health insurance plans believe they drive up prescription drug costs by assisting patients in satisfying part or all their individual out-of-pocket costs.
Many people living with a chronic disease have come to rely on this kind of financial assistance to access their medicines and have no idea their health insurers are no longer accepting the patient assistance towards their out-of-pocket limits. Patients often find out mid-year when they’re stuck with thousands of dollars in charges for their prescription refill because they thought they had already met their out-of-pocket maximum for the year.
SB 565 will make sure health insurance plans continue to count patient assistance, no matter where the assistance comes from, towards out-of-pocket maximums for the year.
PNWBD monitors legislation that affects the bleeding disorders community and advocates for changes in policy when needed. We work hard to keep up to date on issues and work to educate our local politicians and health care officials about bleeding disorders and the resources for those affected to maintain the quality of life.
You have the power to impact the future of your own access to better treatment and care through your own advocacy. Policymakers in Salem, OR and Washington, DC need to hear from you in order to make educated and informed decisions on legislation impacting you and your family. Their awareness of bleeding disorders starts with you. Become your own advocate and make a difference.
As a constituent, advocacy is a powerful tool. There are many ways you can reach your legislators. The most common and effective forms are writing a letter, sending an email, calling your legislator, and meeting with your legislator and/or their staff. Learn how to get in touch with your federal, state, and local elected leaders at https://www.usa.gov/elected-officials.
Just contact us to find out more about becoming an effective advocate at email@example.com.