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FAQ

What is Patients for Prescription Access?

Patients for Prescription Access is a coalition of like minded patient advocate groups and individuals and who are committed to making access to affordable medications a reality for Massachusetts residents regardless of their medical condition.

Why are Co-Pays so expensive sometimes?

One of the main goals of The Affordable Care Act was to expand access to insurance for those who couldn’t afford it, and to make sure that patients, especially those who live with chronic illnesses, can afford the medications they need in order to survive.

Yet unfortunately, for the millions of patients who have chronic diseases and require specialized medications—those living with cancer, arthritis, Multiple Sclerosis, HIV/AIDS and other chronic conditions—that access remains elusive. Why? Because insurers typically place prescription drugs on different levels depending on how expensive and specialized they are. The more specialized, the higher the tier they’re placed on, and the more those patients have to pay.

What’s Co-insurance?

Many use co-insurance where the patient has to pay a percentage of the cost of the actual medicine sometimes as much as 50% of the cost. So despite paying insurance premiums month after month, the sickest patients are being forced to pay more and more of their healthcare care costs due to insurance companies that target those most ill. Co-insurance puts patients in the untenable situation of choosing between their medicine and basic life needs like food, mortgages, and utilities etc. Many patients end up trying to stretch their medications out by skipping doses.

What happens when people can’t afford their medications?

Studies have shown that higher cost-sharing often results in lower adherence because patients either do not fill a prescription, or they stretch out their doses. (Study published Dec 23, 2013 Journal of Clinical Oncology). Non-adherence cost tens of billions of dollars a year in related medical costs, including hospitalizations and trips to the emergency room.

Who is affected?

According to a 2014 Avalere Health analysis, 52% of plans require coinsurance of 30% or higher for ALL drugs covered in at least one class. In addition 86% of plans place ALL covered drugs in at least one class on the highest formulary tier.

Leukemia & Lymphoma Society commissioned a report (Jan 2014) and found that some plans require patients to pay up to 50% of the costs of cancer therapies that are placed on specialty tiers. The report was done by Milliman, Inc.

What can I do? 

Take action. Join the movement. It is through our collective voices that we will be heard. We are currently in the process of drafting legislation that would limit the use of specialty tiers and co-insurance. Our legislators need to know that this is an important issue. But clicking here and going to our take action page you can make a difference in our state by taking a stand for affordable healthcare for all.