Rep. Johnson Seeks Relief for Chronically Ill Seniors

Press Release

Rep. Hank Johnson (GA-04) today introduced his bipartisan "Part D Beneficiary Appeals Fairness Act" (H.R. 3613), which would give seniors on Medicare Part D who rely on "specialty tier' drugs an appeals process when dealing with the high costs of these prescriptions.
With the period of open enrollment for Medicare Part D ending yesterday, seniors are continuing to see their health plans place drugs used to treat chronic illnesses on specialty tiers.

Private and employer health insurance plans classify prescriptions using tiers to differentiate among generic, brand name and "non-preferred" brand name drugs. Any medication costing more than $600 is automatically placed on a specialty tier that requires patients to pay from 25 to 33 percent or more -- rather than a flat rate.

For many seniors on a fixed income, these life-saving drugs for everything from cancer to rheumatoid arthritis, lupus and multiple sclerosis can cost upwards of $1,700 per month. Seniors who can't afford the medication often go without treatment.

"How can we look our seniors in the eye -- people suffering from leukemia, Crohn's disease or multiple sclerosis -- who are required to pay more in prescriptions than they bring home each month -- and say "sorry, you're out of luck. It's either food on the table and roof over your head or the life-saving drugs -- you can't have both,' " said Rep. Johnson.

"We appreciate Congressman Johnson being a long-standing champion of Medicare beneficiaries who live with severe chronic conditions and are faced with very high cost-sharing for their medications," said Sandra Raymond, President and CEO of the Lupus Foundation and leader of the MAPRx coalition. "This bill is the first step to bringing fundamental fairness to these beneficiaries."

MAPRx is a coalition of beneficiary, patient advocacy, family caregiver and health professional organizations committed to improving access to prescription medications and safeguarding the well-being of beneficiaries with chronic diseases under the Medicare prescription drug benefit.

Amy Melnick, vice president of Advocacy for the Arthritis Foundation, also a member of MAPRx, said, "the Arthritis Foundation is grateful to Rep. Johnson for introducing this legislation, which not only raises awareness of the discriminatory nature of the specialty tiers in Part D for people with chronic conditions, but, more importantly, also establishes a critically important appeals process or "tiering exception" so that Medicare beneficiaries can appeal the placement of their medications into a specialty tier."

The president and chair of the Alliance for Biotherapeutics, Abbie Cornett said specialty tiers are creating barriers in access to care and are a threat to all patients who rely on biotherapeutics and other lifesaving therapies. "This legislation is a great way to help our most vulnerable seniors with severe and often chronic conditions," she said.

Johnson called his bill, which has gained the support of 33 co-sponsors, "a common sense, limited approach to ensure that we keep the promises we made to our Medicare seniors."

Co-sponsors include: John Conyers (D-MI); Barbara Lee (D-CA); Mike Honda (D-CA); Raul Grijalva (D-AZ); Marcia Fudge (D-OH); Louise Slaughter (D-NY); Eleanor Holmes Norton (D-Washington, D.C.); Keith Ellison (D-MN); John Lewis (D-GA); Walter Jones (R-NC).

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