Prescription drugs

Prescription drugs are expensive. New Ohio bill could bring relief | Health

For many Ohioans, prescription drugs are just too expensive, even with insurance. Co-pay assistance programs can offer some financial relief, but often patients end up paying all the freight anyway, since the costs covered by these programs are not factored into their deductible.

This means that even if they don’t pay the full cost of their prescriptions, they end up paying that cost on other medical care until they hit their deductible.

A bill at the Ohio House aims to change that.

Bill HB 135 would allow patients to count co-pay assistance programs toward their deductible, the amount a person must pay out of pocket before insurance begins to pay. Proponents say it would allow patients to better afford care and alleviate some real hardships some people face when they get sick and can’t afford their medication.

“Health care in general is very expensive,” said Leo Almeida, director of government relations for the American Cancer Society, which advocates for legislative change.

And co-pay assistance programs, which are supposed to help alleviate some of that cost, aren’t always helpful.

“Let’s say you take a prescription and your out-of-pocket payment for that prescription is $500. You have this co-payment assistance. The pharmacy applies the $500, so you get that drug for free that month,” he said. “But your insurance company doesn’t apply that $500 to your annual deductible. So it’s a benefit over the counter at the pharmacy, but it’s not a long-term benefit because you’re still paying your same deductible through your insurance. So you basically just pay it down the road.”

Julie Turner from Tipp City, Ohio is a cancer survivor. After her chemotherapy and radiation treatments, she lost her bone density, she said.

She is now taking medication to treat this side effect, but the medication is very expensive, so she applied for and received co-payment assistance through her medication manufacturer.

But the copay assistance program didn’t help her at all, she says.

“The help I was so excited about — being a retired person on a fixed income — was going to help me, but in essence it was no help at all,” Turner said. “Because later in the year, I was paying back the $1,500 of my maximum outlay.

This reality can be particularly costly for people with chronic conditions. According to an article in the Journal of the American Medical Association (JAMA), the average spending by people with diabetes in 2018 was over $2,000. For about 8% of people, personal expenses amount to more than $5,000.

Insulin – a life-saving drug for people with diabetes – accounts for 18% of all out-of-pocket expenses.

The PAN Foundation – which provides co-payment assistance – said it has helped people with rheumatoid arthritis, people who need medication to improve their mental health and people with all types of cancers.

The situation for some may be so dire that the organization said it has encountered people considering taking out a second mortgage on their home to pay for medication or skipping medication before finding co-payment assistance. Nearly 60% of Americans have delayed or gone without essential medical care due to high costs, and Medicare patients paid an average of $8,000 per person for drugs in 2019, according to the foundation.

A recent survey found that 51% of cancer patients and survivors had taken on debt to cover the cost of their cancer care, Almeida said.

“So if you think about that 51%, there are people deciding between putting food on the table for their family or paying for their prescription,” he said.

HB 135 would help anyone whose medications are so expensive they need a co-payment assistance program, Almeida said. But advocates say they fear the bill will be stalled.

In March, state lawmakers in the House voted unanimously to pass the bill, meaning it has bipartisan support. Since then, he has served on the Senate Health Committee.

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Joan J. Dean

The author Joan J. Dean