Under many private insurance plans, patients with rare diseases continue to pay extremely high out-of-pocket costs because their prescribed medication is often placed on a “specialty tier.” Specialty tiers allow plans to impose high coinsurance, in lieu of a co-payment for expensive drugs resulting in higher out-of-pocket spending for patients. Not only does this place a financial burden on patients, but it has also been shown to discourage adherence to treatment, which can increase overall costs to the healthcare system.
H.R. 460, the Patients’ Access to Treatments Act, would require plans to limit cost-sharing requirements for specialty drug tiers to the level of cost sharing required for non-preferred brand drug tiers. Insurers would be able to charge no more than 10% more for specialty drugs over what is charged for the next lowest tier (non-preferred brand). For example, if an insurer is currently charging $30 for non-specialty tier brand drugs, HR 460 would require the insurer to charge no more than $33 for specialty drugs.
Every day, Members of Congress hear from thousands of constituents with serious issues and valuable causes. Raising awareness of the impact this legislation will have on Americans throughout the country has inspired 135 Members of Congress to stand in support of HR 460. Click here to learn more and to sign on to their letter in support of H.R. 460 PATA.