“An April 2009 survey found that uninsured nonelderly (ages 18-64) are more than twice as likely as insured nonelderly adults to say that they or a family member did not fill a prescription (45% vs. 22%) or cut pills or skipped doses of medicine (38% vs 18%) in the past year because of the cost.(25)

Among nonelderly adults in 2008, 27% of the uninsured could not afford a prescription drug in the past 12 months, compared to 13% of those with Medicaid or other public coverage, and 5% of those with employer or other private coverage.(26)

A September 2009 survey found that during the past 12 months, 26% of American adults did not fill a prescription, and 21% cut pills in half or skipped doses of medicine, because of cost.(27)”

http://www.kff.org/rxdrugs/upload/3057-08.pdf

Even the insured have difficulty in affording biologics to treat RA. If their drug benefit classifies the biologic as a Tier IV drug, then the co-insurance, cost to patient, can be several hundred dollars a month. And, some insurance plans do not cover expensive biologics at all. There are however patient assistance drug programs to help some of these people.

Those on Medicare may also have difficulty affording injectible biologics since they are covered under Medicare Part D. In Part D’s gap in coverage (the donut hole), the patient has to pay 50% of the full cost of the brand biologic (prior to the Affordable Care Act, patients had to pay 100% of the cost of a brand biologic while in the donut hole.) Enbrel costs about $1,500 a month, so a Medicare patient’s out-of-pocket cost could be $750 a month until they climbed out of the donut hole.

Biologics to treat RA are expensive drugs – but there was some hope in that some of them would be going off patent in the next few years. Enbrel’s patent was to expire in 2012, but there’s been an extension of its patent that could extend its price protection for another 17 years.

http://www.nytimes.com/2011/11/23/business/amgens-new-enbrel-patent-may-undercut-health-care-plan.html?_r=2