Securing Manageable Out-of-Pocket Costs for Patients With Private Insurance

Many diseases that were once fatal now are considered manageable, chronic conditions, thanks to new and innovative treatments. 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 impossible.

The problem is only exacerbated by plan designs that make it impossible for patients to understand what their medications will cost ahead of time.

Cancer patients aren’t the only ones left to shoulder prohibitively high costs. They’re also commonly applied to medications for 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 are forced to skip doses to save money--or abandon treatment all together.

For some, the consequences are deadly: Research has found that patients with high-cost sharing for cancer medications are five times more likely to abandon treatment.

Learn more about the cost of cancer care.

The solution

Patients deserve affordable and predictable 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 life-saving medication.

Some states, like New Jersey, Minnesota and Illinois are requiring health insurers to offer plans that provide lower, more predictable costs and meet the unique needs of patients that need specialty medications.