Medication Access for Patients Rx (MAPRx)
MAPRx is a coalition of patient, family caregiver and health professional organizations committed to safeguarding the well-being of patients with chronic diseases and disabilities under Medicare Prescription Drug Coverage. MAPRx member organizations collaborate with national and state policymakers to ensure that beneficiaries have the access to the medication therapies they need and deserve. Read more about MAPRx.
Recently, the members of MAPRx have been focusing on addressing issues of patient access to prescription drugs under Medicare Part D, among other initiatives. Upward pressure on drug prices has led to new cost-shifting procedures under many health benefits plans, including Medicare.
Most health plans, including Medicare, have a listing of all the drugs that are covered under the plan called a formulary. As drug prices in general have been increasing faster than base inflation in the economy, health benefits plan sponsors have increasingly been sharing more of the costs with patients. Now patients increasingly have to pay for a significant percentage of the most expensive drugs as coinsurance where previously they have only been required to pay a modest fee or copay. Technically speaking, this often occurs when drugs are moved from the normal section of a health benefits plan drug formulary to a “specialty tier.”
NORD, along with the other members of MAPRx, is actively raising awareness that specialty tiers and large cost shifts creates a huge burden on individuals and their families. This is an issue that is particularly important to NORD because patient access to orphan products is frequently limited by specialty tier cost-shifting. As a result of this ongoing advocacy effort, 20 members of the House of Representatives have recently sent a letter to CMS Administrator Donald Berwick inquiring about this issue and its impact on Medicare Part D beneficiaries.
Read Rep. Hank Johnson’s (GA-4) letter here.