Pro­tect our ac­cess to medicine

The Washington Post Sunday - - LOCAL OPINIONS - The writer, a rheuma­tol­o­gist, is chair of the Public Pol­icy Ed­u­ca­tion Com­mit­tee of the Rheuma­tism So­ci­ety of the Dis­trict of Columbia.

This spring, a pa­tient with rheuma­toid arthri­tis called me in tears be­cause she could no longer af­ford her med­i­ca­tion. The drug was an ex­pen­sive spe­cialty med­i­ca­tion, and her in­sur­ance co-pay­ment had risen to $2,000 per month. Her joints had felt fine for sev­eral years while tak­ing the drug, and she rightly wor­ried that her arthri­tis would re­turn if the drug were stopped. “I don’t want to be­come dis­abled!” she pleaded.

Ev­ery doc­tor in the Dis­trict has been in a sit­u­a­tion like this. Even in the high-rent ar­eas of Chevy Chase and K Street, where my of­fices are lo­cated, pa­tients strug­gle. As a rheuma­tol­o­gist, I treat au­toim­mune dis­eases and reg­u­larly pre­scribe spe­cialty medicines that can help peo­ple re­cover from de­bil­i­tat­ing joint pain so they can re­turn to work, care for their fam­i­lies, avoid dis­abil­ity and live longer.

Watch­ing my pa­tients re­gain health is ex­tremely grat­i­fy­ing; how­ever, ev­ery day, pa­tients tell me they can­not af­ford their medicines. The most frus­trat­ing part of this is the in­creas­ingly com­mon way pa­tients are forced to share the high cost of a spe­cialty pre­scrip­tion with their health in­sur­ance com­pany — $10 or $20 co-pays for a drug have mor­phed into co-in­sur­ance with the pa­tient pay­ing a per­cent­age of the cost of each pre­scrip­tion. That’s in­tended to turn peo­ple to­ward generic and other less-ex­pen­sive medicines. But some­times a spe­cialty drug is the only one that works.

A per­son with rheuma­toid arthri­tis may be re­quired to pay 20 per­cent to 50 per­cent of the to­tal cost of med­i­ca­tion.

This can range from hun­dreds to thou­sands of dol­lars per month. The pa­tient I men­tioned had to con­sider cheaper al­ter­na­tives that aren’t as ef­fec­tive.

Af­ter years of gnash­ing my teeth at this sit­u­a­tion, I was able to of­fer my pa­tients hope: D.C. Coun­cil mem­bers Mary Cheh (D-Ward 3) and Anita Bonds (D-At Large) have in­tro­duced a bill to limit spe­cialty drug co-pay­ments in the Dis­trict. Sim­i­lar bills have passed in Mary­land and Delaware and are un­der re­view in Vir­ginia and at the fed­eral level. Th­ese bills limit what in­sur­ance com­pa­nies are al­lowed to charge pa­tients for spe­cialty medicines. This strat­egy en­joys popular sup­port among doc­tors and pa­tients.

A re­cent na­tional study of the co-pay­ment prob­lem showed that if in­sur­ance com­pa­nies were to dis­trib­ute spe­cialty drug costs more fairly, in­di­vid­ual pre­mi­ums would in­crease only $3 per year. This dis­tri­bu­tion of fi­nan­cial risk is the pur­pose of in­sur­ance. I un­der­stand that health-care econ­o­mists sug­gest that co-pay­ments can be help­ful to off­set the so-called “moral haz­ard” of free care. From this per­spec­tive, health in­sur­ance ben­e­fi­cia­ries might pur­sue too much treat­ment if the care is free, thereby in­creas­ing costs for ev­ery­one. How­ever, it is clear to me, as an em­ployer who pur­chases health in­sur­ance and as a physi­cian, that the sys­tem has gone too far. While in­sur­ance com­pa­nies and the phar­ma­ceu­ti­cal in­dus­try de­bate costs, the bur­den should not be foisted onto peo­ple suf­fer­ing from painful chronic con­di­tions such as arthri­tis.

That is why cap­ping co-pay­ments is needed.

Un­for­tu­nately, in­tro­duc­ing the bill ap­pears to be the easy part. The Spe­cialty Drug Co-pay­ment Lim­i­ta­tion Act of 2015 awaits a hear­ing in com­mit­tee.

Our neigh­bors in Mary­land and Delaware re­cently gained legal pro­tec­tion from high spe­cialty drug co-pay­ments. D.C. res­i­dents ur­gently re­quire the same. Mem­bers of the D.C. Coun­cil’s Com­mit­tee on Busi­ness, Con­sumer and Reg­u­la­tory Af­fairs can help make the Dis­trict a place where peo­ple can ob­tain the life-chang­ing med­i­ca­tions they need.


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