Policies to Help Patients Pay Less for their Medicines

Teaser image for fact sheet, an overview of five "Policies to Help Patients Pay Less for Their Medicines"

America’s biopharmaceutical companies agree that, for too many Americans, the health care system is not working and needs to change. While medical innovation has made the United States a world leader in the discovery of new medicines, these treatments won’t benefit patients who can’t get them. There are no easy solutions, but patients need real leadership from everyone involved in our health care system to make it work better.

We believe the following policies are the best way to achieve these goals and make sure that patients pay less for their medicines.

Teaser image for fact sheet, an overview of five "Policies to Help Patients Pay Less for Their Medicines"

Teaser image for fact sheet, titled "Policies to Help Patients Pay Less for their medicines: cap patient cost sharing"

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Policies to Help Patients Pay Less for Their Medicines: Cap Patient Cost Sharing

Patients with commercial health insurance are facing increasing out-of-pocket costs for their medicines in the form of growing deductibles, copayments and coinsurance. Health insurers continue to shift costs to patients, despite evidence that high-cost sharing can lead patients to ration medicines or fail to fill their prescriptions altogether, resulting in worse health outcomes for patients and higher health care costs overall. Without capping this cost sharing burden, patients will continue to struggle to afford the medicines they need.

Teaser image for fact sheet, titled "Policies to Help Patients Pay Less for their medicines: cover medicines from day one"

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Policies to Help Patients Pay Less for Their Medicines: Cover Medicines From Day One

Though growth in medicine prices and spending remains in line with inflation, many of the sickest commercially insured patients continue to face high out-of-pocket costs. Unfortunately, when patients must pay more out of pocket for their medicines, they often fail to fill the medicines their doctors prescribe or ration medicines to make them last longer. This can lead to serious complications and worse health for patients, which could ultimately lead to higher overall health care costs.

Teaser image for fact sheet, titled "Policies to Help Patients Pay Less for their medicines: make coupons count"

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Policies to Help Patients Pay Less for Their Medicines: Make Coupons Count

For patients with commercial health insurance, the amount they pay for their medicines is determined by health insurance companies and pharmacy benefit managers (PBMs). New tactics by these companies to block manufacturer cost-sharing assistance, also known as copay coupons, threaten to make it harder for patients to get important treatments for chronic illnesses such as asthma, diabetes, HIV, arthritis, hemophilia and others.

Teaser image for fact sheet, titled "Policies to Help Patients Pay Less for their medicines: offer lower, more predictable cost sharing options."

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Policies to Help Patients Pay Less for Their Medicines: Offer Lower, More Predictable Cost Sharing Options

Many patients with commercial health insurance continue to pay high out of pocket costs, making it harder for patients to afford their prescriptions—even as the amount insurance companies pay continues to grow more slowly, if at all. Unfortunately, when patients must pay more out of pocket for their medicines, they often fail to fill the medicines their doctors prescribe or ration medicines to make them last longer. This can lead to serious complications and worse health for patients, which could ultimately lead to higher overall health care costs.

Teaser image of phrma's fact sheet on policies to help patients pay less for their medicines: share the savings

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Policies to Help Patients Pay Less for Their Medicines: Share the Savings

Many patients with commercial health insurance continue to pay high out of pocket costs, making it harder for patients to afford their prescriptions—even as the amount insurance companies pay continues to grow more slowly, if at all.