Affordability is often promoted as one of the key benefits of biosimilar medications, with the promise of lowering out-of-pocket costs for patients and improving access to treatment. Unfortunately, that has not been my experience in the clinic this year.
We are only four months into the new year and are already receiving calls from patients who have exhausted the funds on their co-pay cards. Patients are looking to us for guidance because their co-pays are often more than $1,000 per month, making the medication unaffordable. They are understandably worried about flaring if they cannot continue treatment and are unsure of what to do next.
While insurance companies are covering biosimilar medications, the high co-pays often make them an unrealistic option for many patients. The challenges created by co-pay maximizers and accumulators only add to the problem. In addition, many manufacturers have changed their patient assistance programs, resulting in fewer patients qualifying for support, and some companies no longer offer assistance beyond co-pay cards.
We have also faced significant challenges this year with medication affordability for Medicare patients. The $2,100 annual out-of-pocket cap has been helpful for some, but for others, even that amount is difficult to afford, despite being spread throughout the year. At the same time, many manufacturer patient assistance programs have changed, and Medicare patients are often ineligible for additional assistance. As a result, for patients who cannot afford the $2,100 annual cost, we are left searching for alternative treatment options.
As nurses, we want our patients to receive the best possible care, and we advocate for them every step of the way. It is frustrating when, despite doing everything we can, we are still unable to help patients access the treatment they need. When patients are scared and angry because they do not know whether they will flare or whether another medication will work as well, it can leave us feeling helpless.