Lowering patient out-of-pocket costs

Insurance reforms are essential to ensuring Americans can afford care prescribed by their doctor and authorized by their insurance company.

Insurance companies and so-called pharmacy benefit managers (PBMs) are negotiating large discounts from pharmacuetical manufacturers but not passing those savings directly on to patients.

Unfortunately, patient out-of-pocket costs continue to climb while insurers are covering fewer drugs [link to fact sheet].

For example, since 2012, insurers have increased the average patient's out-of-pocket cost by 82% even though insurers were paying 45% less for the insulin over that same period of time. Worse still, we know that when insurers charge patients just $10 more per drug, patients see a 33% increase in mortality. In an ideal world, out-of-pocket costs would be eliminated altogether.

Patients with disease like cancer or diabetes already have "skin in the game" -- they are sick and need care to improve their health and quality of life.

Reforms that would help patients access affordable care include:

1. Capping patient out-of-pocket prescription drug costs -- both annually and monthly -- across all market segments including Medicare Part D, individual and small business health exchange plans, and multi-state employer sponsored insurance plans

2. Eliminating out-of-pocket costs for drugs that have been prior authorized by your insurance company

3. Prohibiting insurance company "copay accumulator" programs that prevent patients from counting manufacturer discounts toward a copay and deductible limits

4. Reducing by half the annual deductible limit established by the Affordable Care Act

Other priorities