Florida built its reputation on the promise that a dollar stretches further here, with no state income tax, a business-friendly environment, and a cost of living far below the states that retirees and businesses leave behind. For one of the largest senior populations in the country, that promise holds nearly everywhere except at the pharmacy counter, where fluctuating prescription costs can make managing a monthly budget on a fixed income impossible.
Much of that strain comes from rules that can make affordable care harder to reach even when lower-cost options are available. A senior on a fixed income can face a high price at the pharmacy counter, discover that available copay assistance cannot be used, or learn that a lower-cost cash purchase will not count toward the deductible or out-of-pocket maximum. Patients can also face prior authorization and step therapy requirements that delay treatment their doctor has already determined is appropriate. The result can be thousands of dollars in unexpected costs or delayed care, delays that may ultimately lead to more serious and expensive health problems.
That same affordability challenge hits Florida’s small businesses directly. The owners I work with across Florida’s Hispanic communities are trying to hold on to the health benefits that help them recruit and retain good employees. But rising premiums and out-of-pocket costs make that harder every year, particularly when employees are paying for coverage they may still struggle to afford to use.
Thirteen Florida organizations, led by the Florida State Hispanic Chamber of Commerce, recently wrote a letter asking the state’s congressional delegation to build its healthcare agenda around three priorities: affordability, patient access, and transparency.
Solutions exist right now that will deliver relief. Patients need protection from the prior authorization and step therapy rules that delay treatment a doctor already judged necessary. Medicare recipients should have the same ability as those on private insurance plans to use manufacturer copay assistance, and anyone who finds more affordable care through a cash-pay website should have every dollar count toward their deductible and copay. Floridians also deserve clear information about their coverage, what they will owe and why a prescribed treatment may be delayed or denied.
Voters agree. McLaughlin and Associates polling for Americans for Health Excellence found that health insurance costs rank as the top healthcare concern among voters, and that Americans are ready for more information about where insurers spend their money. The poll also found that 88% of voters support copay assistance cards for seniors on Medicare and 83% support both counting cash-pay purchases toward a patient’s deductible and implementing a flat out-of-pocket cap on prescriptions in Medicare. Lawmakers looking for common ground on healthcare have rarely had a clearer signal from the people they represent.
None of this is new ground for Florida, either. Advocates have worked for years to reform prior authorization and step therapy protocols that can delay care and to ensure that the money patients spend on their prescriptions counts toward their deductibles and out-of-pocket maximums. Measures already before Congress, such as the Every Dollar Counts Act, would address one piece of that affordability challenge by requiring qualifying prescription spending to count toward a patient’s deductible and out-of-pocket maximum.
Every candidate and every sitting member who represents Florida has the opportunity to deliver on healthcare affordability. The seniors filling a prescription and small businesses trying to keep their benefits competitive are watching and will remember who answered them and who asked them to keep waiting.
Julio Fuentes is the President and CEO of the Florida State Hispanic Chamber of Commerce.
