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Issue Background

Patient Access to Treatment Act

Cost sharing for prescription medications should never be high enough to inappropriately restrict or interfere with medically necessary treatment.

Many health insurers are now moving vital medications into specialty tiers with high patient cost-sharing methods. These tiers commonly requiring patients to pay a percentage of the actual cost of these drugs, often costing hundreds or even thousands of dollars, a month. This practices places medically necessary treatments out of reach even for insured patients

Without access to appropriate care, patients with conditions such as rheumatoid arthritis, lupus, multiple sclerosis, and cancer are at risk of disease progression, becoming disabled, or even death.

  • Medications being targeted by insurers are FDA approved and have no inexpensive equivalents.
  • Patients unable to afford medications due to these practices are likely to go without proper treatment, resulting in disability and other serious health complications.
  • Patients who can’t afford critical medications are likely to increase costs on the entire health care system due to disease progression and complications

The Patients’ Access to Treatments Act (HR 1600), introduced by Representatives David McKinley (R-WV) and Lois Capps (D-CA), is a bi-partisan proposal to limit cost-sharing requirements for medications in a specialty drug tier (typically Tier IV or higher) to the dollar amount applicable to drugs in a non-preferred brand drug tier. It would enable patients to access their necessary treatments and limit overall healthcare costs.