Florida must pass bills targeting anti-patient insurance policies
My child has been suffering from severe hemophilia since birth. an old situation, Hemophilia is a disease that prevents blood from clotting properlyResulting in abnormal and spontaneous bleeding. This can result in severe pain, chronic joint disease, frequent large wounds and cuts, excessive bleeding after routine dental procedures and surgery.
Any injury to the head, neck or abdomen can be life threatening.
As a mother, the importance of affordable and timely access hemophilia treatment Can't be exaggerated. Unfortunately, hemophilia is one of the most expensive chronic diseases that anyone can live with, as the average cost hovers around $300,000 per year.
For our family, the preventive treatment to keep my child stable is more than $60,000 a month – more than $700,000 a year. These costs relate only to hemophilia treatments that stop bleeding. If bleeding occurs, the cost of treatment is much more expensive.
After several lengthy battles with our insurance company for coverage and adequate supply of medication, my child has finally settled on an innovative, successful hemophilia treatment that has significantly reduced bleeding. Before this medicine, my child had to be injected several times a day and was in a wheelchair, unable to walk due to bleeding.
Now our quality of life is immensely better, but only because of these life-saving medicines.
Thankfully, to help families offset the high cost of treatment, some drug manufacturers offer Prescription Assistance Program, For our family, the assistance program provides up to $15,000 per year.
However, the money intended to cover the cost of treatment is going directly to our insurance company, which neglects to calculate our deductible or out-of-pocket maximum. This harmful and discriminatory practice is called Co-Pay Accumulator Program,
Because of this policy, our health insurance company is taking money out of co-pay assistance programs and charging more than our cost-sharing responsibilities. Their tactics charged us thousands of dollars, just from the cost of my child's medication.
This is in addition to the $15,000 charge from the drug manufacturer – an amount that far exceeds our deductible and the maximum we can afford out-of-pocket.
There are many challenges our family faces when dealing with hemophilia, and working overtime to make sure our insurance is covered properly shouldn't be one of them. Copay accumulator programs prevent many patients from being able to afford life-saving treatments and medications.
This policy reduces patient access to health care, especially for patients with hemophilia and other chronic conditions.
My advocacy against copay accumulator programs has resulted in difficult conversations with my health insurance company, which defends the policy by saying that payments are a “member responsibility” intended to ensure that members' “interest in the game.” yes.
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This defense of an anti-patient policy fails to account for the thousands of dollars my family has spent living with this disease, advocating for my child, and in treatment costs. My family is not the only family with “skin in the game,” as families dealing with chronic conditions face unique challenges every day.
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I call on Florida state and federal policymakers to join with 19 other states, Washington, D.C., and Puerto Rico to reduce patient health care costs and increase patient access to treatments and medications by passing legislation that bans copay accumulator programs. I urge. Congress is currently reviewing Aid Reimbursement Act (HR 830/S 1375)That includes eight Florida cosponsors.
The Florida Legislature has also reviewed this policy over the years. I encourage Governor Ron DeSantis and Florida lawmakers to make this necessary legislation a priority to continue their effort to reign in anti-patient pharmacy benefit managers and insurance policies.
There is a lot of noise about the cost of health care. I am hopeful that our federal and state policymakers in Florida will support simple solutions, such as a ban on copay accumulator programs, to immediately reduce patients' out-of-pocket costs.
Cindy Mead, Jacksonville
This guest column is the opinion of the author and does not necessarily represent the views of the Times-Union. We welcome a diversity of opinions.
