Countering the Costs – Prescription Drugs and Out-of-Pocket Excess

2015-05-04 | CSRO

May 1, 2015 - Now that most state legislatures are in full swing, legislation to cap patient out-of-pocket expenses for prescription drugs has found a number of supporters.

In 15 states, more than 20 bills address copay costs in a variety of capacities. CSRO’s position supports the idea that high percentage medication co-payments have become untenable and advocates for limited or reduced out-of-pocket liabilities for patients.

Of these states, 13 directly address out-of-pocket issues for most prescription drugs. Here, Oklahoma, California, and Ohio are the furthest along, with CSRO assisting state societies in California and Ohio in advocating for the measure.

At the same time, there has also been a repeat bill from 2013 introduced at the national level, the Patient Access to Treatment Act (H.R. 1600), which seeks to limit some out-of-pocket prescription costs.

These fights have recently been bolstered by the release of a study from the accounting firm Milliman. Milliman researched the cost of establishing out-of-pocket caps on available health plans at all tiers and found almost no increase in cost-sharing would be required to save patients with high-cost medications thousands of dollars. The study was commissioned by the Leukemia and Lymphoma Society, which is also a member of the SAIM Coalition that CSRO has joined.

Less impactful, but still moving in the right direction, six states, including Massachusetts, North Carolina and Oregon, have limited bills in place that focus on protecting specific disease class drugs or treatments from high costs or utilization requirements.

These bills focus on protecting drugs that treat opioid abuse, cancer and multiple sclerosis, and have passed already in Utah and Mississippi this year. 

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