Include specialty medications on a fixed co-pay tier


All conditions should have at least one highly effective innovator drug on a fixed co-payment tier. 

Public and private insurers should place at least one highly effective, innovative medication on a fixed co-pay formulary tier for all conditions to increase access and treatment adherence. 

Why all conditions need at least one innovator drug with a fixed co-pay

For patients with chronic and rare diseases, specialty medications offer significant treatment advances, reduce the risk of disease progression, and improve survival rates. In most cases, a generic or less expensive alternative is not available for their condition.

Patients are making sacrifices in situations where they can’t afford their specialty medications, which are often the hardest to access due to process complexity and affordability challenges.

Zeenal Patel, outpatient clinic coordinator, Alta Bates Summit Medical Center

High cost sharing for specialty medications—which can be as high as 50 percent of the drug’s cost—increase the chance patients will delay starting therapy, skip prescription refills, and interrupt or abandon treatment. Placing a sizeable financial responsibility for specialty medications on patients creates an environment where the most economically vulnerable people have the least access to innovative therapies. 

Without the help of the PAN Foundation, there is absolutely no way that I could have paid for the treatment. They helped lift the financial burden and made paying for my treatment possible.

Amanda, grant recipient