Page 12 - HFA Dateline 2021 Q1 Spring

requiring expensive Within 10 years,
medication, so he MAXIMUM AVERAGE COST his costs exceed
will reliably reach MIKE JOE DIFFERENCE $100,000, while Joe’s
his plan’s OOP limit remain under $10,000.
each and every year. YEAR 1 $8,550 $800 $7,750 The following graph
Average Joe spends highlights this huge
the U.S. average on BY YEAR 5 $46,681 $4,368 $42,313 cost disparity.
out-of-pocket costs,
which is $800 per BY YEAR 10 $104,577 $9,785 $94,792 In summary, it is clear
year, according to BY YEAR 15 $176,380 $16,503 $159,877 that accumulators
the Kaiser Family cause serious short-
Foundation. The table BY YEAR 20 $265,434 $24,836 $240,598 term and long-term
below shows their harm to individuals
cumulative spending who rely on high-
over time. (For this exercise, both the ACA out-of-pocket cost drugs to maintain their health. Maximum Mike and
limit and U.S. average out-of-pocket spend are assumed to Average Joe are imagined, but the comparison of their
increase 4.4 percent each year. This matches the average projected spending over time is not merely a theoretical
annual increase in the ACA out-of-pocket limit from 2014 exercise. These charts show hard-earned money not
to 2021.) being put in a 401k, not being saved for college, not being
spent in pursuit of the American dream. They show lost
In year one, Maximum Mike tops out his out-of-pocket opportunities that will become reality for our families and
spending at $8,550 — compared to Joe’s out-of-pocket friends if accumulator adjusters continue to proliferate.

cost of $800, for a difference of $7,750. With no protection As a community, we must understand the threat that
from copay assistance, this dynamic plays out year after accumulator adjusters pose, educate our lawmakers and
year and Mike quickly faces an overwhelming cost burden. advocate for change.

12 DATELINE FEDERATION < www.hemophiliafed.org