Cleveland, Ohio – About 1 in 4 Ohioans have arthritis. Unfortunately, policies too often used by health insurance companies have left thousands of Ohioans unable to afford medications to help ease their pain.
There is no cure for arthritis diseases such as rheumatoid arthritis and psoriatic arthritis, but early treatment and lifestyle changes such as dietary changes, exercise, surgery, and medications can reduce movement limitations and joint damage. Mild arthritis is often treated with over-the-counter medications such as acetaminophen and NSAIDs to reduce pain and inflammation.
People with more severe arthritis are often prescribed stronger and very expensive drugs called biologics. These types of medicines are made from living sources and are more complex than others. Biosimilars are a popular form of biologics, and although they are cheaper, they are still expensive.
Patients with highly deductible medical insurance have turned to third-party assistance, such as pharmaceutical companies and charities, to offset their medical costs. However, health insurers and pharmacy benefit managers (PBM is an intermediary in the pharmaceutical supply chain) recently implemented a policy called co-pay accumulators that prevents patients from benefiting from assistance.
Insurance companies “store” the financial assistance that patients receive, but do not apply the funds to patient out-of-pocket expenses such as deductibles and co-payments. When the patient’s help runs out, they require the patient to pay the full deductible to access their medicine.
The insurance company will not return assistance to the entity that provided the assistance, nor will it assist the patient. They double-dip all at the patient’s expense and increase their profits.
This practice of cost-passing to patients is now practiced in nine of Ohio’s 10 health plans, treating ailments such as arthritis, multiple sclerosis, cancer and thousands of rare diseases. It unfairly targets patients who need expensive drugs for Nearly all (99.6%) of drug funding now goes to drugs for which there is no equivalent generic drug.
Worse, the cumulative out-of-pocket burden hurts the patients who need it most. Nearly 70% of patients who rely on third-party assistance earn less than her $40,000 a year.
As a healthcare provider, I see patients every day who are struggling with financial problems while trying to manage their illness. Many people now do not reach their deductible and more often delay or even discontinue care and treatment. In addition to causing them, it also leads to treatment that is an additional financial burden for them, their families, and our healthcare system as a whole.
The General Assembly is working to help Ohio patients by reforming the state’s copayment system. Ohio House Bill 135, sponsored by Republican Rep. Susan Manchester of Waynesfield and Rep. Thomas West of Canton, Democrat, prohibits the accumulation of copayments unless generic equivalents are available. doing. It passed unanimously 86-0 and is awaiting consideration by the Ohio Senate Health Committee.
Sixteen other states and Puerto Rico have passed laws banning these policies or regulating their use. Dozens of other states are working on similar laws.
House Bill 135 could help more than 1.5 million Ohioans save money on prescription drugs. This is to ensure that state-regulated health care plans can apply all forms of patient financial assistance against cost-sharing caps. On behalf of Ohio’s rheumatologists and the tens of thousands of patients we care for, I encourage the Ohio Senators to vote YES on House Bill 135.
Dr. Elizabeth S. Rother, president of the Ohio College of Rheumatology, practices medicine in the University Hospital System.
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