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Paying for Specialty Drugs and Insurance

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#1 chriskuo


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Posted 24 August 2011 - 04:49 PM

USA Today ran an article this week (written by Kaiser Health News) which covers the isses

employers and insurance companies are facing with the increasing number and usage of

specialty drugs.


The issues raised here are relevant to many people on this board.

#2 LivingWellWithCML


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Posted 25 August 2011 - 07:49 AM

Good article.  My understanding is that the Drug Parity Act of 2011 is meant to address this issue by ensuring that health insurance policyholders receive coverage "no less favorable than" IV-based chemotherapy:


My particular policy does not have a specialty clause, so the TKIs are covered under normal prescription co-pay amounts ... so I would hope that drug parity wouldn't mess with situations that are already cost-effective for patients (and these situations are definitely out there).  But it should specifically benefit others who are paying (for example) 25%+ of the retail cost on a monthly basis.  Under drug parity, these folks would probably pay up to a certain deductible amount as stated through their **medical** benefits (and not their prescription drug benefits), then have the TKIs covered 100% for the remainder of the policy-covered year.

This sounds like this is a crippling financial situation for many!

I already posted on this, but the National CML Society is going to be meeting with congressional reps from the rare disease caucus on Sept 20 to lobby for lesiglation like the Drug Parity Act ... specifically to help patients who are dealing with these situations.  If you're dealing with a challenge like this, check out their website where you can submit your story that they'll take with them to Capitol Hill.

Dan - Atlanta, GA

CML CP Diagnosed March 2011

Gleevec 400mg

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