A small group of Republicans and Democrats in the House has introduced federal legislation to limit patients’ out-of-pocket costs for biologics and other specialty medications often used to treat rheumatoid arthritis, psoriasis, lupus, multiple sclerosis, and some cancers.
The Patients’ Access to Treatments Act (H.R. 460), which was introduced on Feb. 4, would require health plans to charge the same copayments for biologics and specialty drugs that they do for other off-formulary brand-name medications.
Typically, health plans use a three-tier system with set copays for generic drugs (tier 1), brand-name drugs (tier 2), and off-formulary brand-name drugs (tier 3). But some insurers have moved biologics and other high-cost medications into a fourth tier, where patients pay a percentage of the cost of the drug. The costs of the affected medications range from $12,000 to $48,000 a year or more, and the copays can range from 25% to 33%, according to the American College of Rheumatology.
"Over the past 2 years, hearing the stories of patients struggling to pay for medications that would dramatically improve their lives has been heartbreaking," Rep. David McKinley (R-W.Va.), the sponsor of the bill, said in a statement. "After talking with a number of people in these situations, it was clear action was needed."
Rep. McKinley introduced this legislation in the last session of Congress, but the bill stalled in committee.