November 2014 Edition Vol.11, Issue 11

Patient Affordability: The Most Important Non-Clinical Attribute in Choosing Between Treatment Options

Patient Affordability: The Most Important Non-clinical Attribute In Choosing Between Treatment Options

By Katherine DiPaula, Associate Consultant at Kantar Health

Patient access and affordability to drugs and treatments continue to be key issues in healthcare, specifically in oncology. A number of factors that are contributing to the financial crisis many patients face include:

  • Payers increasingly shifting the burden of healthcare costs onto patients
  • The Affordable Care Act (ACA) marketplace plans vary widely in terms of cost and coverage
  • Many newly insured patients are not likely to understand the myriad of insurance plans, designs, and options available to them
  • States that have chosen not to expand Medicaid have created a “coverage gap,” leaving millions of people with incomes under 100% of the Federal Poverty Line (FPL) without insurance and ineligible for marketplace subsidies

Assistance from drug manufacturers is essential to patients’ affordability to healthcare and will ensure that providers are not eliminating best treatment choices due to perceived financial hurdles.

Factors Increasing Patients’ Financial Need

The trend of rising premiums, deductibles and cost-sharing continues among commercial health insurance plans. According to a Kaiser/HRET survey, the amount that workers contribute to single-coverage premiums has increased 94% from 2004 to 2014, while workers’ contributions to family coverage have increased 81%. Additionally, the rising trend of coinsurance for specialty drugs in the pharmacy benefit can have a significant financial impact on a patient. According to Kantar Health’s 2014 Payer Survey, patient cost sharing for drugs on specialty all brand and specialty non-preferred commercial formulary tiers were more likely to be coinsurance than a copay (Figure 1). The mean coinsurance rate for specialty brands was 42%, compared with a $91 copay on the specialty brands on a single specialty tier formulary or $93 for preferred and $156 for non-preferred specialty brands. This represents a substantial difference in drug costs. 

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