Illinois patients forced to pay higher costs for medications, putting tremendous burden on families Print
News Releases - Health, Medicine & Nutrition
Written by Vanessa Figueroa   
Tuesday, 11 March 2014 08:05

It’s a sad but simple fact – patients suffering from life-threatening or chronic illnesses need access to their prescribed medications. How they pay for them, though, is another story.

Despite paying insurance premiums like everyone else month after month, these patients are being forced to pay a much higher percentage of their healthcare costs as insurance companies jack-up the co-payments for more and more medicines, putting an even bigger burden on those who are suffering already.

Unless you are dealing with this, you probably don’t even know that insurance companies divide prescriptions into tiers, which typically have fixed co-payments. Many of these companies have added a “specialty tier,” which is a fourth category of medicines that requires the patient to pay co-insurance, or a percentage of the drug price.Often, newer, more expensive or more specialized medicines are placed on these specialty tiers and require a sizable out-of-pocket payment by the patient.

Medications needed for life-threatening or debilitating diseases - like oral medicines for cancer or factor for patients suffering from hemophilia – may cost a patient between 25 to 50 percent of the total cost of the drug.

Senator Linda Holmes (D-Aurora) is taking an important step to protect patients across Illinois by introducing Senate Bill 3395 to limit patients’ cost-sharing burden, ensuring that any required co-payment to drugs on a specialty tier does not exceed $100 per month.

Joan McGovern, whose husband recently passed away from hemophilia, has first-hand experience worrying about prescription drug costs. Mr. McGovern took Factor 8 for nearly 20 years to manage his disease. Her husband was on Medicare and received full assistance and did not have to pay for Factor 8. If the assistance program did not cover him, he would have had to pay the increased percentage of the co-pay for Factor 8 under the “specialty tiers” category. This would have meant that Mr. McGovern would have had to pay close to $700 every other day for Factor 8 to ensure that he had the life-saving medication he needed to prevent hemorrhaging from his brain and throughout his joints.

Joan also has a 3-year-old grandson who lives with hemophilia. His medication is currently covered by his insurance, but as his condition continues to evolve so will his medical needs. And, sadly, his family will end up having to pay for these exorbitant out-of-pocket costs under the “specialty tiers,” which could add up to over $300 per week.

The reality is that most families aren’t able to afford expensive medications under these specialty tiers. Patients, who are already suffering, should not have the extra burden of extremely high out-of-pocket costs to manage their illness.