Co-pays are high and health care is far from optimal for Americans with chronic obstructive pulmonary disease (COPD), says a new report from The Lancet Respiratory Medicine Commission. Penned by 28 respiratory health experts, “Meeting the challenge of COPD care delivery in the USA” provides an inside look at why patients with the chronic, widespread and debilitating disease aren’t getting the care they need.
Though access challenges are multifaceted, the report identifies two primary barriers to appropriate care for COPD patients: coverage and cost-sharing obstacles, and hospitals’ failure to follow the recommended standard of care.
Coverage and Cost-sharing Obstacles
“As a physician,” explained MeiLan K Han, MD, lead author for the commission, “I can discuss best treatments with my patients, only to later find out it isn’t covered by their insurance, or the co-pay is simply too high.” The report notes that COPD patients may have co-pays of $75-$125 or more per prescription medication.
That may be why patients admit to skipping doses, taking lower-than-prescribed doses or not getting their refills. The report suggests that, “Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending.”
Restrictive formularies also present a problem. The report explains that formularies may include only one brand in a particular drug class – and that covered drug can change abruptly. “Patients are often notified by their pharmacy or via a letter that they have to switch medications, and the alternative treatment is not always suitable,” the report states, adding that “These changes frequently cause considerable confusion and frustration for patients and health-care providers.”
[Watch: Understanding Non-Medical Switching]
The report also notes that Medicare’s “complicated coverage and reimbursement structure” presents additional challenges for seniors with COPD.
Standard of Care
One in three hospitals fails to follow recommended guidelines for COPD patients, the report reveals, explaining that “COPD has not been a priority in inpatient settings.” One in five COPD patients are readmitted to the hospital within one month. The report’s authors suggest reducing hospital admissions altogether by better diagnosing COPD and improving access to treatment and care outside of the hospital. They also recommend better education for physicians and patients alike.
Researchers have calculated that more than 10 million physician visits, 1.5 million emergency room visits and nearly 700,000 hospital stays result from COPD.
The report was featured at the American Thoracic Society conference in San Francisco and published in The Lancet Respiratory Medicine Journal.