The Senate followed the lead of their House colleagues Wednesday with a unanimous vote to cap out-of-pocket rates for so-called specialty tier drugs. These include treatments for chronic diseases like hemophilia, multiple sclerosis and lupus as well as some cancers and HIV.
Many prescription insurance plans require patients to pay a coinsurance rate as high as 50 percent of the cost of drugs in the specialty tier. Some of the drugs cost more than $10,000 for a month’s supply.
Tracy Orwig of the Leukemia and Lymphoma Society says some patients can’t afford to take their medicine. “Some do have to make, unfortunately, choices between mortgages and other bills and getting their medication to survive,” Orwig says.
Patients not taking their drugs pay more than just a personal price. A New England Health Institute study estimated that people who don’t take their medication regularly cost the nation $290 billion a year.
Orwig says the trend over the last several years has been to include more expensive drugs in specialty tiers, and to replace flat prescription co-pays with coinsurance rates that are a percentage of the whole cost of the drug. The bill approved by both chambers of the General Assembly caps co-pays at $150 for a 30-day prescription.
“Some patients with various chronic illnesses take many specialty drugs, so you can see the compounding impact that this would have,” Orwig said. “It’s really going to be a life-saver for patients and families with chronic illnesses such as cancer, HIV, lupus, multiple sclerosis, hemophilia, and many others.”
Joshua Bond, whose two-year-old son has hemophilia, told lawmakers his insurance requires a 20 percent coinsurance payment for the specialty tier drug his son needs, which costs $1,502 per three doses – leaving him with a $300 bill each time he orders it.
For certain cancer drugs, the costs can be many thousands of dollars. Gleevec, for chronic myelogenous leukemia, costs roughly $7,000 per month. Revlimid, for myeloma, costs about $13,000 per month. The price tag for Incevek, used to treat Hepatitis C, costs about $16,000 per month, and the standard course of treatment is three months.
Insurance companies CareFirst and Kaiser Permanente testified in support of the legislation.
The Senate and House have to marry their versions of the bill before sending it to the governor’s desk.