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It's increasingly difficult to get affordable, effective health care.
North Carolinians are facing rising out-of-pocket costs—and having trouble getting insurance plans to even cover the treatments they need to stay healthy.
Health insurance companies make record profits as costs soar in U.S."
-CNN, February 2022
46% of insured adults struggle to afford out-of-pocket costs.
29% have not taken medicine as prescribed because it’s too expensive.
-Kaiser Family Foundation, December 2021
Have you visited the pharmacy counter to pick up a prescription only to be shocked at the cost, even though you have insurance?
Even as insurers reap record profits, copays and out-of-pocket costs are on the rise, especially for North Carolinians who need medications the most, like those living with cancer, HIV/AIDS, arthritis, multiple sclerosis and other debilitating and life-threatening conditions.
Health plans often require providers to obtain prior authorization (insurance approval) before prescribing medications. They also increasingly require patients to try and fail on a series of medications before they will cover the medication that works.
Insurance roadblocks like these can take several months to navigate, while North Carolinians go without treatment.
Insurance companies don't disclose what they pay for medications. But we know that Pharmacy benefit managers (PBMs) negotiate so that that health plans don't pay the public “list price." Instead, the cost may even be lower than what the consumer pays out-of-pocket.
Health plan and PBM profits indicate that consumers are paying the price. The Federal Trade Commission is currently investigating.
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Fair Health North Carolina is a project of the state's leading patient and provider organizations.
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