Rare Disease Drug Therapy Adds to Out-of-Pocket Costs

Unfortunately, rare diseases, often treated with specialty drugs, can drive up health care costs for patients who don’t have an insurance plan to sufficiently cover the full cost of treatment or the required medication.

As an employer providing a health insurance plan, you can help your employees mitigate those costs while simultaneously keeping your costs affordable. Planning and education are key factors in keeping expenses down for anyone who’s prescribed drug therapy for a rare disease.

Take Stock

Start by reviewing the prescription options you offer your employees. Usually, prescriptions are covered as part of the general health plan. Try to give your workforce more than just one health care option by working with your insurance carrier to provide several viable choices for your employees.

Often, the differences in these plans surround the out-of-pockets costs that the patient sees, including the cost of prescriptions. Your employees might only look at their share of the monthly premium, but those numbers can be misleading. For a patient who doesn’t visit the doctor much, a low monthly premium is great. For a patient with a chronic illness, however, a low monthly premium means much higher costs when he or she uses a plan benefit (like seeing the doctor or filling a prescription) because the deductibles are higher on these plans.

Utilize What You Have

Take advantage of the tools and resources your insurance carrier provides. As members of a health plan, your employees can call into the patient support line to inquire about specific drug costs.

Since specialty drugs that treat rare diseases can have a significant impact on your employees’ personal budgets, encourage them to engage with the insurance carrier instead of guessing about the price or outcome of care benefits. During the open enrollment period, ask for a representative from the health insurance carrier to come speak to your employees about all the health benefits in the plans, from wellness programs to new drug therapies.

Communicate, Communicate, Communicate

Encourage your employees to contact the drug company that makes their rare disease drug therapy. In addition, encourage any employee with a rare disease to join a local or online support group for people with the same affliction. These groups tend to offer a lot of unofficial but invaluable information that may include online chats with doctors who treat the condition.

If you have an employee with a rare disease, be sympathetic to the time, cost and discomfort he or she endures because of the medical problem. Provide as many in-house resources as possible, and be flexible with the accommodations you make to provide a comfortable workplace.

This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.

Dylan Murray has an MBA from San Diego State University and a bachelor’s degree in communication from Boston University. He is a licensed insurance agent in California, but he works as a professional researcher and writer reporting on business trends in estate law, insurance and private security. Dylan has worked as a script analyst with the Sundance Institute and the Scriptwriters Network in Los Angeles. He lives in San Diego, California and Marseille, France.

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