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Perspectives: Solutions needed for rising insurance premiums

| Monday, Nov. 21, 2016, 8:57 p.m.

As executive director of Community Liver Alliance, I often hear from patients struggling with rising out-of-pocket prescription insurance costs they pay for critical medications.

We try to help as much as possible, but our financial assistance program can't begin to scratch the surface in terms of aid.

Recently, I had an opportunity to talk with a group of patients suffering from a rare liver disease. They need to pay thousands of dollars per month for a new treatment. Many can't afford it and opt out.

Even with health insurance safeguards enacted through the Affordable Care Act, the cost of prescriptions is skyrocketing. People pay for and are covered by their insurance premiums, but for patients like those I work with (many of whom take multiple medications), simply having insurance isn't enough.

Unfortunately, my role has taught me how limiting insurers have become when it relates to helping patients handle rising out-of-pocket costs. Yes, the ACA bans insurers from refusing to cover pre-existing conditions, but that doesn't actually stop them from finding ways to make medications for chronic and life-threatening conditions practically unaffordable. They use cost-shifting tactics and other methods to make it increasingly difficult for patients to get the drugs they need.

If you think it couldn't happen to you, then think again because it's not just the chronically ill who are experiencing these problems. In conversations with my colleagues across health organizations, I've learned this is also impacting everyday, hard-working residents across the state.

Nearly 25 percent of families surveyed by the Urban Institute last year who had coverage through their employers, the ACA or other commercial insurance plans reported difficulties paying medical bills in the past 12 months.

With open enrollment running Nov. 1 through Jan. 31, that's a sobering statistic.

Here are a few more: According to an article in the Oct. 18 edition of The Wall Street Journal, market leaders that are continuing to sell coverage through the exchanges have been granted average premium increases of 30 percent or more in six states and 50 percent in six others, including Pennsylvania.

More specifically, the Pennsylvania Insurance Department approved rate increases for 2017 ACA health plans that average 32.5 percent higher for individual plans and 7.1 percent more for small group plans. Eleven counties in our region have only one insurer offering plans through the marketplace.

I now wonder: Will any of us be able to find any policies we can afford? And if we can afford the policy, will the coverage be enough? What is insurance for after all?

When costs are too high, many patients end up trying to stretch their medications by skipping doses or stopping their medicine completely, resulting in unthinkable consequences. Some patients even put off paying for basic needs to cover the rising costs of their monthly co-pays.

No one should have to choose between buying groceries and paying for their prescriptions. Our life-saving drugs and therapies are simply unaffordable for so many in Pennsylvania.

Lawmakers are finally starting to take notice of the significance of this issue, thanks in part to an Oct. 25 hearing in Harrisburg to discuss a Senate proposal, which seeks to limit out-of-pocket costs on “specialty” medications like the ones our patients need to maintain their quality of life.

This hearing was a positive first step in shedding light on the larger issue of affordable prescription coverage.

Please join me in urging lawmakers to support legislation that provides residents with increased access to medications through more affordable insurance pricing.

We must work together to find a solution for all Pennsylvanians.

Suzanna Masartis is executive director of Community Liver Alliance in Pittsburgh.

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