Impatient

Helping make the health care system work for you

Are you paying an arm and a leg for your specialty drugs?

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84489 full

Do you have a condition – like cancer, hemophilia or multiple sclerosis – that requires a drug in a "specialty tier?"

Are you paying a lot – out-of-pocket – for that drug?

Last week, KPCC community health reporter Adrian Florido reported that some patients are paying up to one-third of the cost of their specialty drugs, instead of just a standard co-pay.

That has spurred a coalition of 23 patient advocacy and provider groups to write a letter to insurance commissioner Dave Jones, asking him to investigate whether specialty tiers might violate a state law banning discrimination based on a medical condition.

Florido writes that HIV/AIDS, hepatitis, epilepsy, seizure disorder, diabetes, clinical depression, bipolar disorder, multiple sclerosis and heart disease are defined as "disabilities" under the California Government Code. He quotes from the advocates' letter:

It is our opinion that certain patients with certain medical conditions on certain medications are being forced to pay much higher OOC [out-of-pocket costs] and are being discriminated against.

"It’s a problem for consumers when they get hit right up front with thousands of dollars that they didn’t expect to pay for," Liz Helms, with the California Chronic Care Coalition, told Impatient. "We feel that is discrimination for people with chronic disease."

Why this price disparity?

Florido says health plans have generally opposed efforts to regulate specialty tiers. They say forcing insurance companies to spread the cost of specialty drugs among all their customers would raise premiums.

The underlying problem is the soaring cost of specialty drugs, Nicole Kasabian Evans, a spokeswoman for the California Association of Health Plans, told him.

If you or someone you know is in this situation, we want to hear from you. Which drug are you taking, and how much does it cost you? How is the price of the drug affecting you?

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