Turning the Screw on Neuropathy Patients

Today's article by Natacha Pires from the American Neuropathy Association (see link below) focuses on a growing problem across the world, where resources are being stretched and cut by the current financial crisis. The cynics among you may wonder if the cut-backs are not just an excuse to pass more costs onto the 'consumer', in this case patients. After all, insurance companies are not known for their philanthropy! The article talks about the situation in the U.S.A. where 'specialty tiering' is making insurance policies much more expensive for people with long term illnesses. However, wherever you come from, you may soon notice similar changes in systems and policies which make it financially more difficult to get the necessary treatment for HIV and neuropathy.

Cost-Shifting Strategy Threatens Access to Neuropathy Treatments
By Natacha T. Pires, M.B.B.S. August 30, 2011

Challenging economic conditions have health advocates increasingly concerned about specialty tiering—a cost-shifting strategy being used by insurers to saddle patients with an unfairly large share of drug costs—and its potential to impede access to life-saving treatments.

What is Specialty Tiering?

As prices of specialty drugs (or prescription medications that are used to treat complex, chronic diseases and require special administration) rise, efforts to shift more of the costs to patients are rampant. Some 90% of Medicare Part D prescription drug plans1 and some 10% of commercial health plans—covering more than 20,000,000 Americans—have created a special pricing tier for specialty and injectable drugs known as specialty tier (or Tier 4). Instead of paying a fixed co-pay amount, people with these plans pay co-insurance, some­where between 25% and 33% of the cost of the medication each month. This can mean hundreds or even thousands of dollars more per month in out-of-pocket expenses for some people.

The report How Much Does that Medication Cost?, released earlier this month by NERA Economic Consulting (commissioned by Pfizer Inc), analyzed Medicare Part D beneficiaries' knowledge of the out-of-pocket costs associated with drugs placed on specialty tiers:
•Many survey respondents were unaware that Part D insurance plans charge differently for expensive medicines used to treat complex, chronic diseases. Half of the survey respondents mistakenly believed their plan would require them to pay a co-pay rather than coinsurance for a drug on the specialty tier.
•Respondents also underestimated the amounts they would have to pay out-of-pocket for specialty tier drugs.
•The findings suggest that most beneficiaries are unlikely to anticipate the financial impact of being prescribed a specialty tier drug or having a current medication moved to that tier.

How Can Specialty Tiers Impact Access to Your Neuropathy Treatments?

Specialty tiers can cause serious financial hardship for people with a chronic neuropathy who rely on specialty drugs, including biologically derived therapies such as intravenous immunoglobulin (IVIG), to maintain their daily activities and improve their quality of life.

Due to the shift in costs from health plans to patients caused by specialty tiers, medications can become prohibitively expensive—which can be catastrophic for patients. Tiers are intended to offset a health plan’s costs for expensive specialty drugs while encouraging lower utilization of such drugs. However, this can be counterproductive and raise overall healthcare costs if the tiers lead to non-adherence to therapy and excess hospitalization.

Specialty-tier medications often do not have generic alternatives and are the only drug available, leaving patients with no effective alternative therapy. For example, the impact of specialty-tiers on intravenous immunoglobulin (IVIG) therapies is of particular interest to our community. The burdensome coinsurance rates for these drugs forces patients to pay out-of-pocket expenses ranging from $652.00 to $8,344 per month.2

How is The Neuropathy Association Fighting for YOU?

The Neuropathy Association is working with patient and professional advocacy organizations as well as policymakers to introduce legislation that prevents health insurers from moving vital medications to Tier 4 status. The objective: Ensure patients’ ability to afford the life-saving medications they need.

New York is the only state with a law preventing specialty tiers. Legislation is being introduced in as many states as possible to ban specialty tiers due to their discriminatory nature. States where bills have been, or are being, introduced include: AZ, CA, FL, GA, HI, MD, MN, NE, NM, PA, and VA. If passed, these bills would put a cap on the amount of co-pays and limit the amount of out-of-pocket expenditures for high-cost medi­cations. The California legislation would also prevent private insurers from creat­ing specialty tiers through co-insurance. Federal legislation will be introduced to reverse the trends in Medicare, as well as the specialty tiers affecting our military (under the TriCare program) and federal employees (under the Federal Employees Health Benefit program).

While we continue to work on this issue, we’d like to hear about how specialty tiering is affecting you. Please write to us at editor@neuropathy.org. And, be sure to review your health plan choices carefully during open enrollment (begins on October 15th and ends on December 7th).

References:
1. “Drugs On Specialty Tiers” by Elizabeth Hargrave, Jack Hoadley, and Katie Merrell, for MedPac, February 2009, No. 09-1.
2. John E. Dicken, Director of Health Care for the Government Accounting Office (GAO). March 17, 2010.

http://www.neuropathy.org/site/News2 page=NewsArticle&id=8091&news_iv_ctrl=1101