All posts by Arthritis Foundation

Let’s Add an Out-of-Pocket Cap in Medicare Part D

My name is Andrea Penny Greenblatt, and I’ve had psoriatic arthritis for over 35 years. I’m also an Arthritis Foundation Advocate.

About four years ago, I joined the Medicare program and faced unexpectedly high out-of-pocket costs on Medicare Part D. Last March, when I participated in the Arthritis Foundation’s Advocacy Summit, I told as many people as I could about my challenge. At that time, there wasn’t much anyone could do since no solutions were being discussed. But I’ve been reading about what Congress is now trying to do to cap out-of-pocket costs, and I wanted to share my story so more patients like me don’t have to suffer.

Since enrolling in Medicare, my overall medical expenses are less than when I was on private insurance. Premiums are lower, and I haven’t had much trouble seeing any doctors and providers. Unfortunately, my initial transition into the program was difficult due to high out-of-pocket costs for my biologic under Medicare Part D. I initially decided to enroll in Part D because my biologic was an injectable medication that was already working well for me, and I didn’t want to disrupt any of my care.

I quickly learned that paying for the Part D drug was going to be financially challenging. The bottom line was that I simply could not afford the coinsurance for the drug that was treating my arthritis. The coinsurance was almost 40%! Exacerbating this issue is the fact that individuals enrolled in Medicare are not allowed to benefit from any form of copayment assistance, which I had been able to access with my prior employer.

After discussing the prohibitive costs of the Part D drug with my doctor, we agreed I should consider transitioning to a physician-administered drug under Part B. I was nervous about abandoning the Part D drug, which had worked so well for me. It turns out my concerns were well-founded: After initial treatment with the Part B drug, I had unpleasant side effects. Since that infusion didn’t work, my doctor decided to try a second infused drug. The second drug seems to be helping, but it’s the only other alternative medication available, and I’m worried it could fail, too.

It’s disappointing Part D doesn’t have any true out-of-pocket cap to limit what individuals pay for medication. I remember my employer health insurance was the opposite: Before enrolling in Medicare, I had an annual limit on my share of costs. Medicare Part B has been a lifeline and helped protect me from financial hardship. I’m fortunate to have a supplemental plan that limits my expenses and helps keep costs more predictable throughout the year.

The addition of an out-of-pocket cap in Medicare Part D is overdue. This change would make Medicare even more successful for me and millions of other Americans. If I had remained on the Part D medication four years ago, my monthly costs would have averaged $600-$700 per month. That’s simply too high for someone on a fixed income, especially when my costs would not be capped each year. My income today only allows for copayments of $200 at the most for my arthritis medication. In addition to an annual out-of-pocket cap, policymakers should consider ways that patients like me can spread costs throughout the entire year. That would help with affordability challenges and might allow me to go back to my Part D drug, which had worked so well to keep my disease at bay when I first joined Medicare.

There are days when I wish I could have afforded the Part D drug that was making a difference in my health. It turns out I’m not the only one: The Arthritis Foundation recently completed a survey showing that other arthritis patients have experienced the same thing – forced to transition from Part D to Part B due to affordability issues. If you’ve had a similar experience on Medicare, sharing your story is so important. Your story helps raise awareness about access and affordability issues across the country. Here are some actions you can take:

 

Top Tips for Testifying at a Hearing!

In October, I joined forces with fellow Arthritis Foundation advocates to testify on step therapy reform. We traveled to the Massachusetts State House in Boston and shared our stories with legislators. Testifying at a bill hearing may seem intimidating, but here are my tips for making it less scary.

Remember that you are your legislator's boss

Legislators want to hear from their constituents. They appreciate you taking the time to come and weigh in on a bill that matters to you. It if helps you, bring notes to reference.

Remember, its impossible for legislators to know about every bill being debate, so it is our job to educate our legislators on what is happening to the millions of Americans with arthritis.

It's ok to say "I don't know"

Legislators don’t expect you to know everything about the bill.  In the unlikely event that they ask you a question and you don’t know the answer it is perfectly appropriate to say “I am not sure, but will follow up with you to get the answer.” Then the staff from the arthritis foundation can help find the answer!

You are the expert of your story

No one knows your story better then you do.

That is why you are at the hearing to testify; to share your story and to show how the legislation can impact millions of patients just like you.

You have the chance to make a difference and you CAN do it! With these tips, you’ll be ready to share your story and advocate on legislation that would make a difference to the arthritis community. Remember, elected officials are just like you and me!

You can take action today by sending a message to your legislator about federal step therapy reform via the Action Center. With just a few minutes, you can let your elected officials know that you support breaking down barriers to care for people with arthritis.

 

 

 

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Expanding Your Expertise at the Live Yes! Advocacy Leadership Retreat

Big announcement! The Arthritis Foundation is excited to be hosting our top advocacy volunteers from around the country March 9-10, 2020, for the Advocacy Leadership Retreat in Washington, DC.

At the Advocacy Leadership Retreat, participants will gain the tactical skills necessary to mobilize their local communities to break down barriers to care. This 301-style event is designed to provide opportunities for champion-level volunteers to teach and learn from their peers. Continue reading Expanding Your Expertise at the Live Yes! Advocacy Leadership Retreat

How to Change Unreasonable Insurance Rules

Tricia’s story is like many others trying to make arthritis coverage more affordable

My name is Tricia Mershon, and I live with my family in Corona, California. At the age of 3, my daughter, Rachel, was found to have a dysfunctional immune system. Her tiny body failed to mount a response to infection, and various disease specialists were able to document the phenomenon but unable to pinpoint a cause.

Just before ninth grade, Rachel’s fingers curved into a funny “s” shape and looked different than those of anyone else. When she began having pain in her feet, knees and hips, which sometimes made walking difficult, Rachel was promptly referred to rheumatology, and we found the real culprit. At 14, Rachel was diagnosed with juvenile idiopathic (rheumatoid) arthritis. She began aggressive treatment to halt the progression of this insidious disease. Continue reading How to Change Unreasonable Insurance Rules

Out-of-Pocket Costs: An Out-of-this-World Problem

Let’s face it: out-of-pocket costs for patients with chronic diseases like arthritis are consuming an ever-growing share of household spending. Lowering drug prices has been a central priority of Congress and the Administration this year, and while a lot of attention is paid to drug companies and insurers, the impact on the patient often gets lost. There may be a lot of chatter about list prices, rebates, and other technical terms, but at the end of the day the health care price that matters most to patients is the one coming out of their own pocket. Continue reading Out-of-Pocket Costs: An Out-of-this-World Problem

How Gaye Jacques Is Making Arthritis a Priority in the 2020 Election

New Hampshire is one of a handful of states with a special fifth season — Primary Candidate Visit Season. Gaye Jacques decided to take advantage of it by trying to meet as many of the Democrat primary candidates as she possibly could, bringing their attention to the barriers to care people with arthritis face every day. Continue reading How Gaye Jacques Is Making Arthritis a Priority in the 2020 Election

Safe Step Act Needs Your Support

Read about what step therapy put a young arthritis patient through.

My name is Sophie Sherman, and I am a rising high school senior from Brookline, Massachusetts. When I was 11, my parents started to notice that I wasn’t acting like myself. Instead of spending time with my friends after school, I would take four-hour-long naps on the living room sofa. Instead of asking for seconds on pasta night, I would barely touch my plate. It seemed like everything I did, be it physical or mental, consumed every ounce of my energy. Continue reading Safe Step Act Needs Your Support

Advocates Gather in Harrisburg to Advocate for Patient Protections

In Pennsylvania, we’re working on legislation to streamline patient access to care. And we can’t do it alone. On June 5, Arthritis Foundation Advocates traveled to Harrisburg for a state legislative day. They shared their stories with legislators and asked for support on two important bills. Continue reading Advocates Gather in Harrisburg to Advocate for Patient Protections