Patient Profile: Out-of-Pocket Cost Burden for Rheumatoid Arthritis Patient

Last month, we walked through how managing chronic myeloid leukemia with a health insurance exchange plan can leave patients with burdensome out-of-pocket costs and put patients’ access to medicines at risk.

Today, we’re sharing Rebecca’s patient profile. Rebecca is a hypothetical health insurance exchange patient developed with the help of Avalere Health. She is 53-years-old and lives in Florida working at a daycare. She also suffers from rheumatoid arthritis.

Because she earns 20 percent above the federal poverty line, she also qualifies for some additional cost-sharing subsidies to cover her health care costs. Still, Rebecca finds that getting the medicines she needs may cost more than she can afford in a given month.

More than 1.3 million Americans struggle to manage rheumatoid arthritis. But unfortunately for those managing chronic conditions, health insurance exchange plans may require burdensome upfront costs to access needed medicines. If a patient can’t afford to pay out of pocket, they are often forced to go without. Rebecca can’t leave the pharmacy with her medicine and pay for it later. Federal cost-sharing subsidies are meant to help with these costs, but the way her plan is designed may leave her without anywhere to turn.

Visit the Access Better Coverage website and our Patient Profiles for information on understanding health insurance and getting the information you need to choose the plan that is best for you and your family.

Get updates on Out of Pocket Cost and/or other relevant issues here.