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Four states adopt first-in-the-nation laws to protect patients from surprise insurer practices

Nick McGee   |     July 15, 2019   |   SHARE THIS

West Virginia, Virginia, Arizona and Illinois recently became the first states in America to adopt patient-centered legislation to bring relief and more predictability to patients facing high out-of-pocket costs for prescription medicines.

Under the new laws, health insurance companies must count manufacturer cost-sharing assistance toward a patient's deductible or out-of-pocket spending limits. 

Patients who have high deductible health insurance plans can sometimes pay thousands of dollars out of pocket on the full cost of their medicines before they reach their deductible. These patients often suffer from chronic conditions yet still end up shouldering these high costs. That’s unfair.  

Unlike care received at an in-network hospital or physician’s office, patients with high deductibles or coinsurance often pay for their medicines based on the full list price of a medicine, even if their insurer receives a steep discount. 

As a result, patients are being forced to bear more of the cost of their medicines out of pocket. In fact, patients with a deductible have seen their out-of-pocket costs for brand medicines increase 50 percent since 2014.

Prior to these new laws, many health insurance plans prevented biopharmaceutical manufacturer cost-sharing assistance from reducing the amount patients have to pay in their deductible phase. To make matters worse, this change in plan design often came as a surprise to patients.

Now, patients will receive significant protection from these high out-of-pocket costs and predictability with their prescription drug costs moving forward. This is an important step in protecting patients who use medications to help battle chronic diseases like hemophilia, cancer, HIV, multiple sclerosis, arthritis, hepatitis and those with rare diseases, among others.

As policymakers continue to look for solutions to the challenges patients are facing, states like West Virginia, Virginia, Arizona and Illinois are setting the roadmap for working across the health care system and the political spectrum to take meaningful steps to ensure patients can afford their medicines. 

To learn more visit www.LetsTalkAboutCost.org.

Nick McGee

Nick McGee Nick McGee is a director, public affairs, at PhRMA focusing on communications strategies and activities for the organization’s state advocacy priorities. Prior to joining PhRMA in 2017, he worked as a Capitol Hill communicator and congressional campaign advisor. Nick is a native Hoosier and struggling Indianapolis Colts fan. Nick and his wife are foodies who love to travel, cheer on the Nationals and hang out with their goldendoodle, Tucker.

Topics: Out of Pocket Costs, Let's Talk About Cost

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