Overcoming High Copays for Specialty Drugs

The Patient Protection and Accountable Care Act, aka Obama Care, lacks accountability when it comes to drug costs. A Sacramento Bee report, identified that to keep insurance premiums low some insurers are being allowed to charge patients hefty copays for specialty drugs. This includes many MS and Cancer patients that need this medicine to help hold the disease process in remission. The kicker is that this policy varies depending upon where you live. For example the article cites that a cancer payment has to pay up to $2,000 for a month of Gleevec treatment in California, whereas if you live in New York a patient will pay only up to a $70 copay. These disparities could affect outcomes of patients that live in certain geographic regions further burdening the health care system as these illnesses progress to a more complicated state requiring a higher level of medical intervention.

The problem that I am having with these cost disparities is that health care reform was supposed to ensure a more affordable solution for all, including those with chronic or preexisting conditions. According to the implementation timeline at Healthcare.gov, the health insurance marketplace will be opening on New Year’s Day 2014 which will allow people and small businesses to get affordable, transparent health insurance. If I am in the market for health care insurance when the health insurance marketplace opens, I am sure going to read the fine print when it comes to specialty drug cost.

If you are having trouble paying for your specialty drugs now you may want to look no further than your pharmaceutical company for support. Many manufactures of specialty drugs offer patient financial assistance. For example, I use Tysabri to treat my MS. I went to a patient experience presentation hosted by the manufacturers of Tysabri and learned that they have a copay assistance program. I didn’t know if I would qualify or not, so I looked up the website and then called the 1-800 number. They reviewed my case and it turned out that I did qualify which reduced my high copayment down to 10 bucks a month.

So, while you can’t change where you live, you may not be responsible for the price disparities in specialty drugs in this health reform landscape. There are programs available to help you with your copayments. Check your pharmaceutical company’s website, see if there is financial assistance and make the call. A simple phone call could take all the worry about the high cost of your monthly medication.

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3 Comments

  1. Matt,

    Thanks for the information. I’m a Tysabri patient and couldn’t make it without the treatment.

    If I lost my healthcare and my Tysabri treatment, I don’t know what I would do.

    • Matt Cavallo

      Hi David,

      Thank you for the comment. As a fellow Tysabri patient, I know exactly what you mean. Luckily if there is a change in your healthcare insurance there is help. Click on the bold copayment assistance program text in the blog and it will take you to the financial assistance website. Even if you don’t need it now, it is good to know that it will be there if you ever do need it.

      Take care,

      Matt

  2. Deirdre Kelly

    The CA Affordable Health Plans ALL charge % on Specialty Drugs so folks with Cancer, MS, Aids will shortly be paying 10%, 20%, 30%, 40% up to FAMILY OUT OF POCKET MAXIMUM $12,400/year. Currently under Blue Cross HMO copay is $150/month for Sprycel for CML Leukemia. Under OBAMACARE that could be 10% $840/month, $20% $1,600/month , 30% $2,400/month or 40% $3,200/month up to the family out of pocket max…

    What’s worse is they are forcing insurance companies to ONLY offer same benefits as the AffordableHealthPlans.

    BOTTOM LINE IS THESE PLANS ARE UNAFFORDABLE FOR THE CHRONICALLY ILL…

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