Limit total out-of-pocket costs for all patients


Out-of-pocket costs should not prevent individuals with life-threatening, chronic, and rare diseases from obtaining their prescribed medications.

The administration, Congress, and public and private insurers must consider total out-of-pocket cost of care when developing policies to ensure that out-of-pocket costs for prescription medications are affordable and do not prevent patients—especially those with lower or fixed incomes—from starting and staying on medically necessary treatments.

High out-of-pocket medication costs frequently prevent patients from accessing their prescribed medications. When faced with high out-of-pocket drug costs, patients with serious conditions take longer to start treatment, are less likely to fill their prescriptions, and experience increased interruptions in treatment.

Multiple studies have shown that even a monthly co-pay of $40 for a medication can cause many patients to forgo filling their prescriptions. With many essential medicines for serious conditions requiring much higher co-pays, high out-of-pocket costs prevent patients from accessing the treatment they need and exacerbate widening economic insecurity for older adults.

While reducing out-of-pocket expenses for prescription therapies is an important goal, it is equally vital that patients have affordable access to the other healthcare services. Co-pays for visits to primary or specialty providers, and out-of-pocket costs for services such as diagnostic tests, physical therapy, radiation, or any other form of treatment, should not prevent patients from getting the care they need, nor force patients to make difficult trade-offs between healthcare and paying for other essentials like food and groceries.

When I was diagnosed with Parkinson’s disease, each new prescription would eat through our savings until there was nothing left.

Lynn Estep, Indiana
Living with Parkinson’s disease