The Growing Need for Co-Pay Assistance The National Congress for the Un and Under Insured September 2008.

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Presentation transcript:

The Growing Need for Co-Pay Assistance The National Congress for the Un and Under Insured September 2008

For more information contact: Julie Reynes, Agenda The Under-Insurance Problem A Changing Healthcare Environment Impact of Changes on Co-Pay Assistance Needs Page 2

For more information contact: Julie Reynes, How Big is the Problem? The Commonwealth Fund, estimates that 25 million people in the US, under 65, are underinsured Being “underinsured” is defined as having out-of-pocket healthcare costs exceeding 10% of their income (or 5% for lower income adults) This is a 60% increase in the number of underinsured from 2003 to 2007 Quite often individuals must make difficult decisions between paying for rent and daily necessities or paying for life-saving medications These numbers do NOT include the millions of Americans over 65 who are under-insured, have Medicare, but no supplemental insurance, or have no insurance at all. Page 3

For more information contact: Julie Reynes, Healthcare Costs Are Increasing Source: 2008 Milliman Medical Index Page 4

For more information contact: Julie Reynes, The Impact of Being Underinsured Page 5 Source: Commonwealth Fund Biennial Health Insurance Survey

For more information contact: Julie Reynes, Why Co-Payment Assistance? Pharmacy cost trends upward exceeded all other components of medical care from Source: 2008 Milliman Medical Index Page 6

For more information contact: Julie Reynes, Why Co-Payment Assistance? Prescription drugs have the largest co-payments Prescription drug costs are estimated to continue increasing in the near term Physicians and hospitals have the flexibility to reduce or waive their fees for lower income patients If a patient can obtain the thousands of dollars it may cost to access their medications, they will be more likely to get treatment ‘We found that reductions in drug copayments increased medical adherence.’ Michael E. Chernew, Health Affairs, Jan-Feb 2008 Source: 2008 Milliman Medical Index Page 7

For more information contact: Julie Reynes, Changing Healthcare Environment Physicians are increasingly requiring co-payments for drugs before treatment is provided Employees are struggling to handle double digit increases in insurance premiums Medicare payments continue to get squeezed Insurers are increasing co-payments associated with expensive drugs. This currently impacts: 86% of Medicare Part D drug plans 10% of private drug plans Changes from a new administration may increase the number of under-insured Source: Co-payments for Expensive Drugs Soar, The New York Times, April 14, 2008 and 2008 Milliman Medical Index Bottom Line: The need is increasing. Page 8

For more information contact: Julie Reynes, Patient Access Network Dedicated to improving access to needed health services for insured patients who cannot afford the out-of-pocket costs associated with their treatment. A public charity that launched our initial assistance program in October, Currently supports 20 disease-state funds for oncology and chronic diseases. Provides co-pay assistance of from $ $7500 per year for medications. Received favorable advisory opinion from the Office of the Inspector General (OIG) of the Department of Health and Human Services in December Have approved nearly 50,000 patients for cost-sharing assistance. Page 9

For more information contact: Julie Reynes, Patient Access Network Supports the Under-Insured Co-payment assistance is not just for the indigent. It is for patients who might not get life-saving treatments because of the expense. Co-payment assistance is not just for the indigent. It is for patients who might not get life-saving treatments because of the expense. 2 times the Federal Poverty Level for a Household of 4 is $42,400 per year. Source: Patient Access Network Data, Page 10 Approvals by Income Level

The Need for Co-pay Assistance from PAN is Increasing Demand is increasing by over 30% each year, while revenues remain stable Source: Patient Access Network Data, Page 11 Projected 2008

For more information contact: Julie Reynes, A Patient Perspective “I sat in the oncologist’s office and kept saying, I don’t have the money, but I’m not going to die because I can’t pay for this. I am not going to die because I am underinsured.” Judy Hodges, PAN Patient Page 12

For more information contact: Julie Reynes, Conclusions Insured populations are having difficulty accessing needed healthcare Co-payment assistance is an important mechanism for getting help where it is needed We believe that co-pay assistance organizations currently meet only 10% – 15% of the need (based on internal PAN claims-based models) PAN is experiencing unprecedented demand. Without additional support we will be unable to meet this demand. PAN is experiencing unprecedented demand. Without additional support we will be unable to meet this demand. Page 13