Page 10 - HFA Dateline 2021 Q1 Spring

LIMITS ON COPAY

ASSISTANCE CAN

THREATEN FAMILIES’

FINANCIAL SECURITY
FINANCIAL SECURITY

B Y HF A POLIC Y AND AD V OC A C Y TEAM, WITH
BY HFA POLICY AND ADVOCACY TEAM, WITH
ASSISTANCE FROM AN ACTUARIAL PROFESSIONAL
ASSISTANCE FROM AN ACTUARIAL PROFESSIONAL
For many in the bleeding disorders community, drug
For many in the bleeding disorders community, drug to weigh discontinuing treatment or turning to emergency
to weigh discontinuing treatment or turning to emergency
manufacturer copay assistance programs are a source
manufacturer copay assistance programs are a source rooms for care. Both options lead to bad health outcomes
rooms for care. Both options lead to bad health outcomes
of fi nancial relief and the sole protection against and higher overall health spending in the near term. But
of financial relief and the sole protection against
and higher overall health spending in the near term. But
perpetually high out-of-pocket health care
perpetually high out-of-pocket health care people exposed to high year-after-year out-of-pocket
people exposed to high year-after-year out-of-pocket
costs. Unfortunately, health insurers, costs also face long-term, grossly disproportionate threats
costs. Unfortunately, health insurers,
costs also face long-term, grossly disproportionate threats
citing the need to curb medical
citing the need to curb medical to their fi nancial security as well as their physical well-
to their financial security as well as their physical well-
infl ation, are increasingly being.
inflation, are increasingly
being.
refusing to credit copay
refusing to credit copay
When copay assistance is working as intended, it greatly
assistance toward patients’
assistance toward patients’ When copay assistance is working as intended, it greatly
reduces the cost-share for those who must rely on ultra-
deductibles and out-of-
deductibles and out-of- reduces the cost-share for those who must rely on ultra-
high-cost drugs. It effectively levels the playing field,

pocket maximums, via high-cost drugs. It eff ectively levels the playing fi eld,
pocket maximums, via
bringing out-of-pocket expenditures for this population
the implementation of bringing out-of-pocket expenditures for this population
the implementation of
down to a level that is comparable to a person of more
“accumulator adjuster down to a level that is comparable to a person of more
“accumulator adjuster
typical risk. Should accumulator adjusters be allowed to
programs.”
programs.” typical risk. Should accumulator adjusters be allowed to
spread across the insurance landscape, copay assistance
spread across the insurance landscape, copay assistance

ective tool to combat high
would no longer be an eff
This strategy shifts would no longer be an effective tool to combat high
This strategy shifts
thousands of dollars
thousands of dollars patient cost-sharing. Suddenly, many with a bleeding
patient cost-sharing. Suddenly, many with a bleeding
of cost-sharing back to disorder could face the maximum out-of-pocket costs
disorder could face the maximum out-of-pocket costs
of cost-sharing back to
allowed under their health plan, year after year after year.
the patient. Because the allowed under their health plan, year after year after year.
the patient. Because the
eld would be gone and those who rely

The level playing fi
implications of this shift The level playing field would be gone and those who rely
implications of this shift
are far-reaching, addressing
on high-cost drugs to preserve their health would face
are far-reaching, addressing on high-cost drugs to preserve their health would face

this issue has become a top a financial burden starkly different from those of more
this issue has become a top
nancial burden starkly diff erent from those of more

a fi
advocacy priority for HFA
typical risk.
advocacy priority for HFA typical risk.
and many other patient
and many other patient
There is evidence proving this is already happening: A 2019
advocates.
advocates. There is evidence proving this is already happening: A 2019
article from RealClearHealth.com reported, “On average,
article from RealClearHealth.com reported, “On average,
individuals with two or more chronic diseases spend
Accumulators create individuals with two or more chronic diseases spend
Accumulators create
signifi cant confusion, five times more out-of-pocket than patients without any
fi ve times more out-of-pocket than patients without any
significant confusion,
fi nancial risk and
chronic conditions. People with three or more conditions
financial risk and chronic conditions. People with three or more conditions
pay 10 times more.”
barriers to care. Those
barriers to care. Those pay 10 times more.”
confronting high-
confronting high-
To illustrate, examine the out-of-pocket claims spend of
cost sharing may find
cost sharing may fi nd To illustrate, examine the out-of-pocket claims spend of
themselves hard-
themselves hard- two individuals: Maximum Mike and Average Joe. Both
two individuals: Maximum Mike and Average Joe. Both

ordable Care Act Marketplace plan with
ord
have an Aff

pressed to aff
pressed to afford have an Affordable Care Act Marketplace plan with
their prescription
an out-of-pocket maximum of $8,550, the upper limit
their prescription an out-of-pocket maximum of $8,550, the upper limit
refills, forcing them allowed for 2021. Maximum Mike has a chronic condition
refi
allowed for 2021. Maximum Mike has a chronic condition
lls, forcing them

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