Every year, people with insurance sift through hundreds of pages or search online to find the best health insurance plan to fit their individual and family’s needs. It’s an extensive, complicated and exhausting process. Now, thanks to health insurers’ efforts to shift more costs to patients through higher deductibles, these decisions aren’t getting easier.
Complicating matters, the AIDS Institute recently discovered many insurance companies and pharmacy benefits managers across Florida are slipping new language into their plans that are dramatically increasing the cost of drugs for patients. Insurers are instituting "accumulator adjustment" programs, which will no longer count patients’ manufacturer-issued copay assistance toward their annual deductibles. This is resulting in patients being surprised with thousands of dollars in additional costs as they seek to access their life-saving medications.
Copay assistance programs like manufacturer-issued coupons save patients thousands of dollars at the pharmacy counter, especially those with chronic or rare diseases who lack generic options. Many patients would not have access to their life-saving medications without the assistance programs. When people’s out-of-pocket cost of their drugs is within their budget, it increases access to needed treatments and empowers patients to take control of their health. The quiet and nontransparent implementation of these accumulator adjustment programs only burdens patients’ financial and physical health, and in some cases, leaves the patient untreated for an infectious disease.
Insurance plans, like Health First and Molina Healthcare of Florida, and employers such as Home Depot, Walmart and PepsiCo, are essentially punishing the most vulnerable patients who rely on specialty, innovative medications to continue their treatment by implementing these cost-shifting programs. Florida Blue, the state’s largest insurer, has not yet instituted this policy, but in their plan documents state "we reserve the right not to apply" the cost-sharing assistance.
These programs are masked by small print buried deep within insurers’ health plans and are being instituted without patients’ knowledge. This leads to sticker shock at the pharmacy counter, forcing many patients to forgo purchasing their medicines altogether.
Research shows out-of-pocket costs and treatment adherence are directly related; as out-of-pocket costs rise, patients abandon their treatment regimens because they can no longer afford them. This is especially true when out-of-pocket costs hit above $125 — reportedly, 52 percent of patients will no longer adhere to their treatment because it’s too expensive.
Treatment abandonment is a public health crisis, causing patients to get sicker and require more care in the long run. As deductibles continue to rise, we need to find solutions to deal with access issues and unaffordability in the healthcare system. We need a system that doesn’t put the burdens on patients.
Because of insurance companies’ lack of transparency to their beneficiaries in implementing these policies, the AIDS Institute recently wrote to Florida’s insurance commissioner and attorney general asking them to look into these harmful practices.
Most of us and our families are already impacted by the high cost of medications. We hear the blame-game and finger-pointing about who’s at fault for high prices. Patients don’t get the option to negotiate drug prices, they don’t even get the option to negotiate their health insurance terms, they can only purchase the plan or not. So clearly the burden of the cost shouldn’t be on the backs of patients while companies profit. This new practice by insurance companies and PBMs that shift even more costs to patients is wrong and is not the way to increase affordable access to drugs. We should all demand that the health plans must be fully transparent with their beneficiaries about these new harmful policies and put an end to the practice altogether.
Michael Ruppal is the executive director of the AIDS Institute. The institute was founded in Florida more than 33 years ago and is a national nonpartisan, nonprofit organization that promotes action for social change through public policy, research, advocacy and education.