Just having health insurance is no longer enough to ensure access to affordable healthcare.
Today, millions of people covered by commercial health plans, the Affordable Care Act, or Medicare still find themselves unable to afford the out-of-pocket costs required to start and stay on their medical treatment.
The PAN Foundation is uniquely positioned to recommend strategies that improve healthcare access and affordability for those most impacted by rising out-of-pocket costs.
Since 2004, the PAN Foundation has provided a critical safety net for more than one million underinsured people with life-threatening, chronic, and rare diseases who would otherwise have gone without treatment.
Our policy recommendations
Each of the following recommendations prioritizes patients’ needs in our complex healthcare system and focuses on improving healthcare access and affordability for all people living with a serious chronic illness.
Areas of focus
Make healthcare affordable and accessible to all, without discrimination
Public and private sectors have an obligation to address health inequities, making healthcare affordable and accessible to all without discrimination.
Increase diversity in clinical trials
The public and private sectors must increase representation in clinical trials to reduce barriers to care and foster better health outcomes.
Limit total out-of-pocket costs for all patients
The administration, Congress, and insurers must set policies that make out-of-pocket costs for prescription medications affordable for all.
Enhance the Medicare Part D Extra Help program
Congress and the administration should further enhance the Extra Help program to increase awareness and enrollment.
Expand Medicare to include dental, hearing, and vision benefits
Congress should expand Medicare to ensure adequate dental, hearing, and vision coverage and minimize out-of-pocket spending.
Reduce high upfront health insurance deductibles
Commercial health insurers must mitigate the impact that high upfront deductibles have on patients' ability to start and stay on treatment.
Ban co-pay accumulator, maximizer, and alternative funding programs
Ban programs that block access to prescribed medications and lead to greater out-of-pocket costs for individuals with serious diseases.
Adopt value-based insurance designs
Value-based insurance designs increase access to treatment and affordability for people with life-threatening, chronic, and rare diseases.
Make mental health services and medications accessible to all
Older adults should have access to affordable mental health services and support, including appropriate medications.
Continue offering telehealth services
Telehealth can help expand access to treatment and continuity of care for all patients.
Make care management more widely available
Congress and the administration should expand care management to address both the health and social needs of patients.
Curb restrictive utilization management practices
Congress and insurers should take action to minimize disruptions in care by curbing restrictive utilization management on patients.
Maintain the six protected classes in Medicare Part D formularies
Legislative or regulatory changes to the six protected classes policy would erode essential patient protections and cause financial burdens.
Smooth out-of-pocket costs throughout the year
Spread out-of-pocket costs for prescriptions evenly over the course of the year so that patients can afford to start and stay on treatment.
Cap out-of-pocket costs
Limiting monthly or annual costs helps people with Medicare access needed treatment and plan for these costs throughout the year.
Make healthcare affordable and accessible to all, without discrimination
Public and private sectors have an obligation to address health inequities, making healthcare affordable and accessible to all without discrimination.
Increase diversity in clinical trials
The public and private sectors must increase representation in clinical trials to reduce barriers to care and foster better health outcomes.
Limit total out-of-pocket costs for all patients
The administration, Congress, and insurers must set policies that make out-of-pocket costs for prescription medications affordable for all.
Enhance the Medicare Part D Extra Help program
Congress and the administration should further enhance the Extra Help program to increase awareness and enrollment.
Expand Medicare to include dental, hearing, and vision benefits
Congress should expand Medicare to ensure adequate dental, hearing, and vision coverage and minimize out-of-pocket spending.
Reduce high upfront health insurance deductibles
Commercial health insurers must mitigate the impact that high upfront deductibles have on patients' ability to start and stay on treatment.
Ban co-pay accumulator, maximizer, and alternative funding programs
Ban programs that block access to prescribed medications and lead to greater out-of-pocket costs for individuals with serious diseases.
Adopt value-based insurance designs
Value-based insurance designs increase access to treatment and affordability for people with life-threatening, chronic, and rare diseases.
Make mental health services and medications accessible to all
Older adults should have access to affordable mental health services and support, including appropriate medications.
Continue offering telehealth services
Telehealth can help expand access to treatment and continuity of care for all patients.
Make care management more widely available
Congress and the administration should expand care management to address both the health and social needs of patients.
Curb restrictive utilization management practices
Congress and insurers should take action to minimize disruptions in care by curbing restrictive utilization management on patients.
Maintain the six protected classes in Medicare Part D formularies
Legislative or regulatory changes to the six protected classes policy would erode essential patient protections and cause financial burdens.
Smooth out-of-pocket costs throughout the year
Spread out-of-pocket costs for prescriptions evenly over the course of the year so that patients can afford to start and stay on treatment.
Cap out-of-pocket costs
Limiting monthly or annual costs helps people with Medicare access needed treatment and plan for these costs throughout the year.
Make healthcare affordable and accessible to all, without discrimination
Public and private sectors have an obligation to address health inequities, making healthcare affordable and accessible to all without discrimination.
Increase diversity in clinical trials
The public and private sectors must increase representation in clinical trials to reduce barriers to care and foster better health outcomes.
Limit total out-of-pocket costs for all patients
The administration, Congress, and insurers must set policies that make out-of-pocket costs for prescription medications affordable for all.
Enhance the Medicare Part D Extra Help program
Congress and the administration should further enhance the Extra Help program to increase awareness and enrollment.
Expand Medicare to include dental, hearing, and vision benefits
Congress should expand Medicare to ensure adequate dental, hearing, and vision coverage and minimize out-of-pocket spending.
Cap out-of-pocket costs
Limiting monthly or annual costs helps people with Medicare access needed treatment and plan for these costs throughout the year.
Smooth out-of-pocket costs throughout the year
Spread out-of-pocket costs for prescriptions evenly over the course of the year so that patients can afford to start and stay on treatment.
Reduce high upfront health insurance deductibles
Commercial health insurers must mitigate the impact that high upfront deductibles have on patients' ability to start and stay on treatment.
Ban co-pay accumulator, maximizer, and alternative funding programs
Ban programs that block access to prescribed medications and lead to greater out-of-pocket costs for individuals with serious diseases.
Adopt value-based insurance designs
Value-based insurance designs increase access to treatment and affordability for people with life-threatening, chronic, and rare diseases.
Make mental health services and medications accessible to all
Older adults should have access to affordable mental health services and support, including appropriate medications.
Continue offering telehealth services
Telehealth can help expand access to treatment and continuity of care for all patients.
Make care management more widely available
Congress and the administration should expand care management to address both the health and social needs of patients.
Maintain the six protected classes in Medicare Part D formularies
Legislative or regulatory changes to the six protected classes policy would erode essential patient protections and cause financial burdens.
Curb restrictive utilization management practices
Congress and insurers should take action to minimize disruptions in care by curbing restrictive utilization management on patients.
PAN celebrates new health protections for millions thanks to Medicare reforms
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