IDF advocates against harmful insurance preferred product formularies and policies for immunoglobulin replacement therapy. IDF believes that physicians, in consultation with their patients, should make decisions about changes in IVIG treatment as they are in the best position to understand the specific medical history and unique needs of each patient.
Please inform IDF if your insurance plan is instituting a preferred product formulary for Ig therapy. Click here to submit the Ask IDF form and explain your situation.
Traditionally, commercial health insurers have charged flat co-payment fees for different tiers of medications: generics (Tier I), name brands (Tier II), and off formulary brand medications (Tier III). As an example, the co-pays might be set at $10/$20/$50 for the three tiers.
Some commercial health insurance policies are now moving vital medications (mostly biologics such as immunoglobulin which primary immunodeficient patients rely on) into “specialty tiers” that utilize high patient cost-sharing methods. These specialty tiers are now commonly requiring patients to pay a percentage of the actual cost of these drugs – from 25% to 33% or more – often costing hundreds, even thousands, of dollars per month for a single medication. These practices are placing medically necessary treatments out of reach for average Americans.
H.R. 460, the Patients’ Access to Treatments Act seeks to restrain high out-of-pocket costs for specialty medications like immunoglobulin. This bipartisan legislation will help ensure patients with chronic, disabling and life threatening conditions to access the treatments they need. It would limit out-of-pocket costs for medications in a specialty drug tier (typically Tier IV or higher) to the dollar amount applicable to the drugs in a non-preferred brand drug tier.
These biologic medicines have no generic or inexpensive equivalents. In addition to patients with primary immunodeficiency diseases, affected patients include those certain types of cancer like leukemia and lymphoma, multiple sclerosis, rheumatoid arthritis, psoriatic arthritis, lupus, hemophilia, Crohn’s disease, and other conditions. Some of these patients currently endanger their health by having to skip doses or go without treatment altogether due to excessively high cost-sharing.
Supporting H.R. 460 will enable access to critical treatments that allow patients to lead a normal life and prevent disability.
New study shows H.R. 460 would have negligible impact on insurance premiums! View the full study here