Monahan: The Affordable Care Act was designed to make health insurance less expensive, but for some patients with chronic conditions, the cost of prescription medications has grown increasingly unaffordable. A proposed bill in the Massachusetts legislature would cap those costs, keeping patients from financial hardship.

Cora Higson was diagnosed with pulmonary hypertension ten years ago. She takes 10 pills a day—one is literally a lifesaver.

Higson: I wouldn’t’ be able to breathe, my heart would go into strange rhythms.

Monahan: But that one prescription costs more than 11-hundred dollars a month. So every year, Higson applies for grants through a non-profit to subsidize the high out of pocket costs.

Higson; Being able to have that medication, keeps me around.

Monahan: It’s a burden that many with debilitating diseases, like Multiple Sclerosis, and Rheumatoid arthritis face. Insurers put certain, expensive medications in what’s called specialty tiers. Patients pay from 20-50 percent of the actual cost of the drug.

Cindy Steinberg/US Pain Foundation: Many require a co-insurance, rather than a co-pay. People have insurance to protect them in case of getting a terrible illness, so they don’t have financial devastation. And in this situation there is no cap, so people can pay more and more of the cost, and they can’t afford them.

Monahan: Now a bill before the Massachusetts legislature would cap out of pocket expenses at $1250 a year for an individual, and $2500 for a family. Six other states have already signed patient costs caps into law.
In the meantime, Cora has to hope that the grant money keeps on coming—her health depends on it.

Higson: To most people, it’s not a big deal, dishes, laundry, taking out the garbage. I wouldn’t be able to do any of that.

Monahan: States that have the law have seen very little increase in plan premiums, and that’s because there’s such a small number of medication in these specialty tiers.