Neuropathy Community Applauds Enactment of AB 339
Following advocacy by the public health community, AB 339 was recently signed into law, which will help Californians with chronic conditions, like neuropathies, access healthcare by containing certain out-of-pocket costs. The vast majority of Covered California patients will see their specialty drugs capped at $250 per month, per prescription. Overall, the caps will range from $150 to $500 beginning in 2016.
The California law is a response to the increasing utilization of specialty insure tiers that include high co-insurance requirements and often create barriers to accessing therapy for individuals with rare and chronic conditions that rely on innovative life-saving or life-sustaining therapies. As Assemblymen Rich Gordon put it when he introduced AB 339, “Such high cost drugs are often on a “fourth tier” of a drug formulary with coinsurance of up to 20% so a patient may exhaust their annual out-of-pocket limit of $6,500 with a single prescription in the first month.” AB 339 seeks to cap out-of-pocket costs at a more reasonable level and ensure that health plans make necessary drugs available at reasonable prices.
The Foundation and grassroots advocates across the country have been advocating for legislation very similar to AB 339, The Patients Access to Treatments Act (H.R. 1600), which would cap co-insurance driven out-of-pocket costs and promote patient access on a national level. H.R. 1600 is a bipartisan bill that is supported by many leading patient-driven organizations that advocate together as the Coalition for Accessible Treatments. It is important to for policymakers in Congress to follow California’s example and enact national legislation to control the ballooning out-of-pocket costs associated with co-insurance requirements for the following reasons:
- Specialty tiers commonly require patients to pay a percentage of the cost of the drug (co-insurance) that can range from 25% to 50% or higher, costing a patient hundreds, even thousands of dollars, per month out-of-pocket for a single medication.
- Specialty tiers and co-insurance are placing medically-necessary treatments out of reach of average insured Americans.
- A patient’s financial responsibility or cost-sharing for a prescription medication should not be so large that it inappropriately restricts or interferes with medically-necessary use of medications.
- Failure to adhere to a treatment plan because of lack of access to medications can lead to worsening disease, increased rates of disability, loss of function, productivity and independence, and rising health care costs as more patients forego treatment.
If you are interested in becoming an advocate for the neuropathy community and working with other affected individuals to advance critical patient access legislation like A.B 339 and H.R. 1600 please contact anna.yankelev@gbs-cidp.org.