What do you think?

Cost sharing—deductibles, co-payments and coinsurance—is intended to lower health insurance premiums. Yet the number of Americans who are underinsured (spending 10% or more of their income on out-of-pocket medical expenses) has doubled since 2003. And the truth is, studies show underinsured families struggle just as much as families with no insurance at all—45% went without necessary healthcare because they couldn’t afford the out-of-pocket costs.

Read these facts about the impact of cost sharing on families around our nation and decide for yourself: Fair or Unfair?

Fair or unfair
1

In a review of 45 studies on financial hardship of cancer survivors, 62% reported being in debt because of their medical bills and nearly half did not adhere to their prescription medication because of the cost of treatment.

Fair
Unfair

It’s unfair that even with insurance, a good quality of life during and after treatment is not guaranteed. All the amazing advances in medicine today won’t mean much if the people who need them can’t afford them. That’s why the PAN Foundation strongly believes high cost sharing should never stand between anyone and their medical care.

“I was diagnosed with multiple myeloma in August of 2013, and underwent an autologous stem cell transplant the following February. Unfortunately, a chromosome mutated and I had to go right back to chemotherapy again. We purchased the best Medicare Supplemental Insurance plan available, but when I was told the co-pay on one medication would be nearly $3,000 per month, it was quite a shock.” —Ira

Fair or unfair
2

Insurance companies have a “tiered” approach to the out-of-pocket costs for medication, with the least expensive generics in the bottom tier and the highest-cost drugs in the specialty tier. For some conditions, such as chronic myelogenous leukemia (CML), only specialty-tier medications are effective. A patient on Medicare diagnosed with CML might have to pay up to $49,969 per year just to access their medication.

Fair
Unfair

It’s unfair that insurance companies can arbitrarily pick which drugs are in a specialty tier, forcing people with some chronic, life-threatening or rare diseases to pay sky-high prices just to live. The PAN Foundation advocates that insurance companies place at least one effective drug for each condition in a non-specialty tier.

“I am a 74-year-old widow and former art teacher, and I was diagnosed with multiple sclerosis 12 years ago. Within the past year, I learned of a new medication and asked my neurologist about it. After various tests, he said that it might help me. I was astounded when I learned of the cost, but felt that I had to try using it to improve my quality of life.” —Susan B.

Fair or unfair
3

After elders on Medicare Part D pay their deductible and $5,000 in cost sharing, they’re responsible for  5% of each medication—with no cap. Users of specialty drugs can reach $5,000 in the first months of the year, followed by thousands more before the next January resets their deductible.

Fair
Unfair

It’s unfair that our elders most in need of medical treatment find themselves paying a large chunk of their healthcare costs for the year in a matter of months, and then have no limit on the amount they may need to spend the rest of the year—forcing them to choose between their medications and necessities like rent, food and other medical treatments. The PAN Foundation advocates for a cap on Medicare Part D spending and a way to distribute out-of-pocket costs more evenly throughout the year.

“I was diagnosed with multiple sclerosis in 2004 and became permanently disabled in 2011. I believe that the medicine has slowed the progression of the disease and is a game changer for me each and every day. Living with a chronic disease is a challenge, and being on a fixed income makes things a lot more complicated.” —Dennis

Fair or unfair
4

In a 2017 PAN Foundation survey of patients who sought financial assistance for their healthcare needs but were unable to get it, nearly half did not start their treatment.

Fair
Unfair

It’s unfair that so many people in our nation can’t get necessary treatment because of cost-sharing measures originally designed to avoid unnecessary medical spending. The PAN Foundation aims to alleviate this cost-sharing burden so people can access the treatment they need.

“I have Crohn’s disease and it has been over 42 years with no hope of medications to help me. I was prescribed a new treatment in 2012 but couldn’t afford it. I considered not starting the treatment, until my pharmacist mentioned PAN.” —MaryAnn

Fair or unfair
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In 2017, the PAN Foundation provided $347.9 million in financial assistance. With donations from pharmaceutical companies, corporations and caring individuals, we were able to cover deductibles, co-payments and coinsurance for more than 262,500 patients with life-threatening, chronic and rare diseases.

Fair
Unfair

Our healthcare system is broken. That’s why the Patient Access Network (PAN) Foundation advocates for sustainable, long-term policy solutions to make healthcare more affordable for all. But we’re also providing solutions today. Since 2004, we’ve helped nearly 1 million people cover their out-of-pocket treatment costs. From grandmothers to kids, asthma sufferers to cancer survivors, we’re proud to help people access their critical treatments so they don’t have to sacrifice everything else that matters.

Some of those we’ve helped have shared their thoughts on our special Message Wall.

We invite you to visit today to get their stories right from them and then take a moment to leave your own encouraging message for people battling serious illnesses.

Share this page with your network to raise awareness:

“I had to thank the PAN Foundation for their help. Without it, I couldn’t receive treatment for hepatitis C. I am disabled from an accident, and I can barely afford to pay for doctor and blood test co-pays through Medicare. At 57 I was facing a death sentence, as I already have cirrhosis. Now, I have a chance to see my grandson grow up. You see, since my last blood test, hepatitis C has not been detected and I still have about 10 days of treatment left. Money should not be a factor in who can have access to treatment when you are facing a life-threatening disease! The PAN Foundation is saving lives, and everyone there should be commended. I don’t know what to say, other than thank you from my heart.” —Michael