Summary

To amend title XXVII of the Public Health Service Act to limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to... Read More

Status

Bill Text

A BILL

To amend title XXVII of the Public Health Service Act to limit co- payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to the dollar amount (or its equivalent) of such requirements applicable to prescription drugs in a non-preferred brand drug tier, and for other purposes.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Patients' Access to Treatments Act of 2012''.

SEC. 2. CO-PAYMENT, COINSURANCE, AND OTHER COST-SHARING REQUIREMENTS APPLICABLE TO PRESCRIPTION DRUGS IN A SPECIALTY DRUG TIER.

(a) In General.--Subpart II of part A of title XXVII of the Public Health Service Act (42 U.S.C. 300gg et seq.) is amended by adding at the end the following:

``SEC. 2719B. CO-PAYMENT, COINSURANCE, AND OTHER COST-SHARING REQUIREMENTS APPLICABLE TO PRESCRIPTION DRUGS IN A SPECIALTY DRUG TIER.

``(a) Requirement.--A group health plan, or a health insurance issuer offering group or individual health insurance, that provides coverage for prescription drugs and uses a formulary or other tiered cost-sharing structure shall not impose co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier that exceed the dollar amount (or its equivalent) of co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a non-preferred brand drug tier (or prescription drugs in a brand drug tier if there is no non-preferred brand drug tier). ``(b) Special Rule.--If a formulary used by...

Read Full Text

Sentiment Map

Select:

Nation

0 Supporting
0 Opposing
0% 0%

State: CA

0 Supporting
0 Opposing
0% 0%

District: 1st

0 Supporting
0 Opposing
0% 0%

Popularity Trend

Organizations Supporting

Under many private insurance plans, patients with cancer continue to pay extremely high out-of-pocket costs because their prescribed medication is placed on a “specialty tier.” Specialty tiers allow plans to impose high coinsurance, in lieu of a co-payment, for expensive drugs, resulting in higher out-of-pocket spending for patients. This policy has a direct, negative impact upon patient access to needed medicines, and disproportionately affects those prescribed innovative therapies, which may offer greater effectiveness or fewer side effects than older options. Not only does this place a financial burden on patients, but it has also been shown to discourage adherence to treatment. In fact, in a recent study, patients were found to forgo some more expensive therapies altogether or discontinue treatments based on cost . Another study shows the danger of a cost-sharing plan that reduces adherence, demonstrating that adherence to treatment, in spite of the immediate cost, can lower overall healthcare system expenses. While plans operating in the commercial market, and regulated at the federal level, have not traditionally used the specialty tiers structure as often, their prevalence is growing. Since 2005 the percentage of workers in an employer-based plan with specialty tiers has nearly doubled. LLS supports HR 4209, a bill which would limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in specialty tiers to the dollar equivalent of requirements applicable to prescription drugs in non-preferred brand drug tiers. We urge Members to co-sponsor this legislation.

Share

Organizations Opposing

No organizations opposing yet.

Users Supporting

No constiutents supporting yet.

Users Opposing

No constituents opposing yet.

Bill Summary

To amend title XXVII of the Public Health Service Act to limit co-payment, coinsurance, or other cost-sharing requirements applicable to prescription drugs in a specialty drug tier to the dollar amount (or its equivalent) of such requirements applicable to prescription drugs in a non-preferred brand drug tier, and for other purposes.

H.R. 4208the Fisheries Investment and Regulatory Relief Act H.R. 4210the Restore our Neighborhoods Act