Discrimination Against Chronically Ill or Cost Control Measure?
By: Dominick Spatafora, president of the Neuropathy Action Foundation
I am writing today as a multifocal motor neuropathy patient who is prescribed intravenous immune globulin, as well as the founder and president of the Neuropathy Action Foundation (NAF). The NAF is dedicated to ensuring neuropathy patients obtain the necessary resources and tools to access individualized treatment to improve their quality of life. I am extremely concerned about how, in recent years, health plans have been targeting certain chronically ill patients by charging them more for their lifesaving and limb-saving medications and therapies.
Many health plans have created “specialty tier” cost structures, a form of coinsurance that dramatically increases prescription copayments for chronically ill patients. Rather than paying a flat rate for medication, patients with medications on specialty tiers can pay coinsurance of up to 35 percent of the total cost of the drugs. For some patients, that can cost up to $3,000 per month.
Specialty tiers are prescription drug formulary management tools that insurers use to limit their liability and increase the beneficiaries’ share of the costs of certain prescription drugs (sometimes referred to as specialty drugs). These specialty drugs are typically used to treat complex, chronic conditions and are either injected or infused. They may require refrigeration, compounding or other “special” handling. These drugs often do not have generic alternatives and are the only drug available, leaving patients with no effective alternative therapy.
Although any patient might be affected by coinsurance, those patients most affected include those living with specific conditions such as cancer, multiple sclerosis, hemophilia, primary immune deficiencies and certain neuropathies. Health insurance is a means by which health risk is spread across a pool of payers. Yet, when certain serious illnesses like the ones mentioned above strike, patients are singled out or discriminated against for much higher out-of-pocket costs. This practice is appalling and negates the very reason they had been paying for insurance in the first place: to be protected from financial hardship should they become ill.
Specialty tiers are discriminatory because they apply a totally different benefit structure to certain medicines that patients with particular diseases need. By selectively applying high cost-sharing requirements to these drugs, while requiring lower, fixed copayment requirements for other drugs, plans that use specialty tiers force certain patients who suffer from certain diseases to pay much more.
The financial burden of paying for prescription drugs could be a strain for anyone, but it has a potentially devastating impact for those living with chronic conditions. The increased financial burden jeopardizes the financial solvency of entire families and jeopardizes the ability of some patients to take their necessary medications. No one should have to choose between taking life-sustaining medication and paying rent or providing food for their children.
Dominick V. Spatafora is President of the Neuropathy Action Foundation based in Orange County, CA.
Neuropathy Action Foundation
Administrative Office 1950 Old Tustin Avenue Santa Ana, CA 92705 Toll-free: (877) 512-7262 email@example.com