The National MS Society sends a special thank you to Reps. Hank Johnson (GA-04) and Walter Jones (NC-3) for introducing the “Part D Beneficiary Appeals Fairness Act” (H.R.3613) last week. This bipartisan effort, which introduced with 33 original cosponsors, would grant people with disabilities and seniors on Medicare Part D facing the high cost of drugs placed on the “specialty tier” an appeals process to help combat high cost.
Approximately 25 – 30% of people with MS rely on Medicare for health coverage. Private and employer health insurance plans classify prescriptions using tiers to differentiate among generic, brand name and “non-preferred” brand name drugs. In Medicare Part D, plans are allowed to place any medication costing more than $600 is automatically placed on a specialty tier that requires patients to pay a co-insurance or percentage of the drug cost. Drugs to help manage MS can exceed $30,000 per year or more than $800 per month out of pocket. MS therapies are routinely positioned among the top 12 drugs most often found on a specialty tier—making people living with MS who need the drugs to stay healthy pay a 25 to 33% co-insurance. This places a substantial financial burden on people living with MS—with some choosing to forego treatment simply because they cannot afford their prescriptions.
Rep. Johnson’s bill would offer patients unable to shoulder the high cost of specialty tier drugs an appeals process or “tiering exception”—specifically, they would be appealing to pay a lower cost-sharing amount. The appeals process is available on every other drug tier in Medicare and this bill would simply ensure this consumer protection was applied to every tier, even the most expensive drugs that are especially hard to afford. As a result of this bill, people living with MS would be assured to have a means to appeal to have better access to critically important prescription drugs that slow the progression of this incurable disease and help reduce the frequency and intensity of flare-ups. Click here to read the press release from Rep. Johnson.