Patients with serious chronic diseases who depend on these drugs can incur costs of up to hundreds of thousands of dollars each year.
At least seven states, including Delaware, Louisiana, Maine, Maryland, Montana, New York and Vermont, have imposed limits on out-of-pocket payments for patients in private health plans. For instance, Montana’s cap is $250 per prescription per month. Delaware, Maryland and Louisiana have $150 monthly caps and Vermont’s is $100. Maine has an annual limit of $3,500 per drug, according to the report.
New York prohibits insurers from listing specialty drugs in a separate category that enables them to charge higher out-of-pocket payments.
Legislators in other states, including California, Massachusetts and North Carolina, have proposed requiring drug companies to make financial disclosures justifying high drug prices, but no such law has passed as of yet, according to the report.
Critics of pharmaceutical pricing have said these measures could help bring some relief to patients who need expensive specialty drugs, but they would ultimately fail to control the rising drug prices initiated by drug makers. Further, they argue consumers will likely incur more expensive out-of-pocket payments and health insurance premiums as pricey specialty drugs become more commonplace.
“None of those measures is going to be very effective in my view because they don’t get at the underlying issue of how drug prices are set,” said John Rother, president and CEO of nonprofit National Coalition on Health Care.
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