In an era where healthcare should advance towards greater accessibility and efficacy, it's deeply troubling to witness the hurdles placed in the paths of those most in need. As we stand at a critical juncture, the call for Congress to champion the cause of protecting vulnerable patients has never been more urgent.
It's a sobering truth that the shadow of chronic illness touches many corners of our society, casting a pall over the lives of friends, family members, and colleagues alike. I have two elderly parents in their 80s, and each has suffered from a chronic illness.
With the Centers for Disease Control and Prevention (CDC) estimating that 129 million Americans are battling major chronic diseases such as cancer, diabetes, or heart disease, the magnitude of this issue is undeniable. The grim reality is many of us will face chronic medical conditions or have a loved one who will have to overcome such a prognosis. These conditions have health implications and the severe daily limitations they impose on sufferers, making even simple tasks Herculean efforts.
While numerous state legislatures have boldly stepped forward, enacting measures to safeguard patients within their jurisdictions from the predatory strategies of health insurers and their affiliated pharmacy benefit managers (PBMs), the extent of their reach has its limits. Specifically, these protective measures need to cover individuals under employer-provided insurance schemes, thereby leaving a significant gap in the blanket of patient protection. This gap underlines the critical need for federal action, calling upon Congress to enact comprehensive protections against the detrimental practices of insurers.
An increasingly troubling trend has emerged where vulnerable patients rely heavily on copay assistance programs to manage the exorbitant costs of their medications. These programs, primarily funded by drug manufacturers, are lifelines for underinsured and financially struggling individuals, enabling them to adhere to prescribed treatment plans. A great example is my 81-year-old mother, who has to rely on a 48-month program offered by the cancer drug manufacturer to afford her prescription. But where there is a profit to be made, those who can profit will find a way to gouge the public.
Insurers and PBMs have craftily redesigned their policies to undermine these assistance programs, refusing to count the aid towards patients' deductibles or out-of-pocket maximums. This manipulation exacerbates financial strains on patients and effectively erases any semblance of the intended relief, forcing many to abandon treatment due to cost prohibitions.
The harsh consequences of these insurance schemes are not mere speculations but are reflected in real-life tragedies and struggles. For instance, the heart-wrenching testimony of Jen Hepworth, a mother fighting for her daughter’s life against cystic fibrosis, starkly illuminates the dire repercussions of policies that fail to count critical assistance towards deductibles. When patients like Hepworth’s daughter are forced to forgo life-sustaining drugs due to financial barriers, the cost is measured in human lives, not just dollars and cents.
Recognizing the growing prevalence of such obstructive practices, with the Drug Channels Institute reporting in 2023 that a significant majority of commercially insured beneficiaries are enrolled in plans that employ copay accumulators and maximizers, the urgency for a legislative solution has never been more apparent. Fortunately, the tide is turning with bipartisan support rallying behind initiatives like the HELP Copays Act, H.R. 830. This proposed legislation, enjoying the backing of over 130 cosponsors from both political spectrums, aims to dismantle the barriers erected by copay accumulators and maximizers.
Ultimately, it becomes clear that insurance companies and Pharmacy Benefit Managers (PBMs) should not have the power to dictate which medications are made available to patients. This critical decision-making process rightfully belongs in the hands of patients along with their trusted physicians. In light of this, the appeal for Congressional action emerges not just as a call to action but as a desperate plea for justice, advocating for a return to the core values of healthcare where the well-being and health of patients are the foremost priority. Given that the health and welfare of countless individuals are precariously poised, it is of utmost urgency for Congress to respond promptly and enact comprehensive legislation that puts an end to the predatory practices endangering Americans' access to necessary medications.
This legislative action is not just a mandate but a moral obligation to safeguard the foundational right to health, ensuring that every individual can access the care they need without undue interference from profit-driven entities.
Leif Larson is a media consultant and media strategist for multiple political candidates and issue campaigns across the country.
