by Amanda Conschafter, blog editor
Patients with respiratory conditions are often not sick enough to be in critical care but not well enough to deal with their symptoms without consistent intervention. So explains a newly released white paper from the Institute for Patient Access and the Alliance for Patient Access’ Respiratory Therapy Access Working Group. Paradoxically, the paper explains, respiratory health rarely gets the policy attention it deserves.
Entitled “Improving Access to Respiratory Care,” the white paper explores the most pressing access barriers – and related policy solutions – for patients suffering from respiratory conditions.
Access to Approved Therapies
Asthma. Co-pays for albuterol inhalers and inhaled corticosteroids can present barriers to patient access, as can insurers’ preference for certain types of inhalers. Innovative procedures and therapies can introduce added access challenges, particularly biologic treatments that get placed on specialty tiers with high co-insurance requirements.
Allergy. Access to allergy immunotherapy, commonly known as the allergy shot, is one of the most urgent challenges to respiratory health access today. Regulatory challenges may erase patient access to and reimbursement for this life-altering treatment, though it would come at great cost to both patients and the health care system.
COPD. The third-leading cause of death in the United States, chronic obstructive pulmonary disease kills more than 130,000 Americans annually. A 2015 recommendation from the U.S. Preventive Services Task Force, however, could limit COPD screening opportunities – eliminating the chance for physicians and asymptomatic patients to have an important conversation about COPD.
Another challenge for COPD patients is non-medical switching; changing a patient’s medication mid-course based on health plan cost considerations with little regard to the physician-prescribed course of treatment.
Idiopathic Pulmonary Fibrosis. This debilitating ailment may prove fatal in a matter of two or three short years. Two new treatments, nintedanib and pirfenidone, can slow progression of the disease. But their cost is so prohibitively high that it presents a barrier for an average patient to access treatment.
It’s critical to encourage screening, lower cost-sharing requirements and protect access to therapies for these and other respiratory conditions, the paper explains.
Access to Full Scope of Respiratory Care
Education and Trigger Mediation. Educating patients on how to use medical devices and prescriptions properly is crucial in the field of respiratory health. Trigger mediation—addressing and mitigating respiratory triggers in a patient’s home environment—is another useful proactive tool to which many patients have no access.
The Expanding Role of Respiratory Therapists. Respiratory therapists provide specialized ongoing care for COPD, chronic ventilator dependence, pneumonia and cardiovascular disease, and also emergency care for patients with various traumas, heart attack, drowning or shock. To help ensure patient access to respiratory therapists’ care, however, Medicare statute and reimbursement policy must acknowledge their role in keeping respiratory patients healthy.
Telemedicine. While the private sector has moved to embrace telemedicine, the Centers for Medicare and Medicaid Services’ payment policies haven’t kept pace with advancements in this aspect of health care. Legislators are attempting to address these issues through numerous bills, including the Medicare Telehealth Parity Act of 2015, which would expand telemedicine providers and services to include respiratory therapists and respiratory care.
To learn more about access barriers and policy solutions for patients with respiratory conditions, read “Improving Access to Respiratory Care.”
