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Prescription out-of-pocket costs

Thanks to the availability of new and innovative treatments, many diseases that were once considered fatal are now treated as manageable, chronic diseases. But to access those treatments, health plans often require patients to pay thousands of dollars in out-of-pocket costs, which for many patients is an impossible barrier to overcome.

Such high out-of-pocket costs are commonly applied to medications used to treat cancer, HIV/AIDS, arthritis, multiple sclerosis and other debilitating and life-threatening diseases.

The patient impact

When cost-sharing becomes a barrier to access, patients find themselves facing difficult decisions about whether to take the medications they depend on or risk the family’s financial stability.

Often in these cases, patients do not use their medications appropriately, skipping doses in order to save money or abandoning a treatment all together. Three out of seven cancer patients report skipping doses or cutting pills as a result of financial pressures.

The solution

Reasonable limits must be placed on the out-of-pocket costs that patients are required by their health plans to pay as their share of the cost of a medication.

Ideally, these limits would be applied to a patient’s out-of-pocket costs regardless of whether the plan deductible has been reached. Otherwise, when patients fill their prescriptions each month, those with higher deductibles are unlikely to experience any improvement in the affordability of their cost-share.