Study Finds That Bill to Protect Patient Access to Medically Necessary Treatments Would Have Negligible Impact on Insurance Premiums

Coalition of patient advocates and medical professionals commissions study of H.R. 460

WASHINGTON, Sept. 10, 2013 /PRNewswire-USNewswire/ -- A bill to protect access to medically necessary treatments for patients with chronic, disabling, and life-threatening conditions would not significantly increase medical insurance premiums according to a study released today by the Coalition for Accessible Treatments.

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The Coalition, composed of professional medical associations and patient organizations, commissioned the study, which was conducted by Avalere Health, a healthcare advisory firm, to assess the potential impact on insurance premiums of H.R. 460, the Patients' Access to Treatments Act of 2013.

"The study found that the bill would have a negligible effect on insurance premiums, increasing premium costs by an average of $3 per year for plans with specialty tiers, absent any other changes to the average benefit design," said Audrey B. Uknis, MD, president of the American College of Rheumatology, speaking on behalf of the Coalition for Accessible Treatments. 

H.R. 460, co-sponsored by Rep. David McKinley (R-WV) and Rep. Lois Capps (D-CA), would protect patient access to medically necessary treatments by lowering patient out-of-pocket costs for specialty drugs in commercial health plans.  The bill was developed through collaboration among leading professional medical associations, patient organizations, and congressional champions for patient care.

"Over the past two years, hearing the stories of patients struggling to pay for medications that would dramatically improve their lives has been heartbreaking and it was clear action was needed," said Rep. McKinley. "We're happy to learn if the bill were to be implemented, this study reveals the 'Patients' Access to Treatment Act' won't significantly increase insurance premiums."

The bill is designed to protect the small percentage of plan enrollees, such as people with autoimmune diseases and certain cancers, who depend on specialty drugs. 

Traditional prescription coverage puts medications on formulary "tiers" with a fixed dollar co-payment for each tier.  A small proportion of commercial health plans of health insurance companies have adopted a new pricing system with "specialty tiers" for expensive drugs, in which patients pay a percentage of the price of the medication rather than a fixed co-payment. 

The result for patients with certain medical conditions requiring expensive medications, many of which are biologics, can be an out-of-pocket cost that makes it difficult or impossible to access a needed medication.

"High out-of-pocket costs for specialty drugs can prevent patients from receiving needed medical care," said Jennifer Griffiths, PhD, Chief Mission Officer for the Arthritis Foundation.  "This can result in serious adverse impacts to functioning, permanent disability, and even death."

Specialty drug spending represents a small percent of overall health plan spending.  According to the Avalere study, specialty spending represents approximately 2 percent of overall health plan spending for commercial plans.

H.R. 460 seeks to assure access to needed medications for patients by requiring commercial health insurers to impose the same fixed co-payment obligations on patients requiring specialty drugs as for patients seeking off-formulary "non-preferred" brand medications.

For the study released today, Avalere Health used the Center for Consumer Information and Insurance Oversight's (CCIIO) Actuarial Value (AV) Calculator and the 2012 Employer Health Benefits Survey to analyze the potential impact of H.R. 460 on commercial health plans.

The members of the Coalition for Accessible Treatments, which funded the study, include: American Academy of Dermatology Association, American Academy of Neurology, American Academy of Pediatrics, American Autoimmune Related Diseases Association, American College of Rheumatology, American Plasma Users Coalition, Arthritis Foundation, Crohn's & Colitis Foundation of America, Colon Cancer Alliance, GBS/CIDP Foundation International, Hemophilia Federation of America, Immune Deficiency Foundation, The Leukemia & Lymphoma Society, Lupus Foundation of America, National Hemophilia Foundation, National Organization for Rare Disorders, National Psoriasis Foundation, Patient Services Incorporated, Pulmonary Hypertension Association, Sjogren's Syndrome Foundation, Spondylitis Association of America, The Alliance for Patient Advocacy, and US Hereditary Angioedema Association. 

SOURCE National Organization for Rare Disorders (NORD)



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