Millions of Americans and their families struggle every day with the devastating effects of Alzheimer’s, Parkinson’s and Huntington’s diseases. They remain hopeful for treatments that can slow, stop or even cure these progressive conditions.
But in a new white paper, physicians and advocates raise a perplexing question: As new therapies for neurodegenerative diseases emerge, will health plans and coverage policies allow patients to access them?
The first white paper from the Alliance for Patient Access’ Physicians Neurodegenerative Disease Working Group, “Protecting Patient Access to Treatments for Neurodegenerative Diseases,” acknowledges the challenges of developing effective medications for these conditions. The process is slow, expensive and plagued by high failure rates.
Yet efforts continue. And the Food and Drug Administration offers accelerated approval and priority review to expedite the process for unmet medical needs. The first FDA-approved treatment for psychosis in Parkinson’s disease patients, for instance, received both fast track approval and breakthrough therapy status.
But the paper argues that health insurance trends suggest continued challenges, even for the rare neurodegenerative disease treatment that is successfully developed and approved. In particular, the group points out as potential challenges:
- Specialty tiers, which can shift a medication’s cost onto patients. When patients cannot handle the costs, they may fail to comply with the prescription regimen prescribed by their physician.
- Medicare Part D challenges. Medicare prohibits the use of co-pay coupons, which can help make medications affordable for patients. Medicare beneficiaries with neurodegenerative diseases may also struggle with the “donut hole” coverage gap until it phases out in 2020.
- Prior authorizations, which delay patients’ access to the treatment.
- Non-medical switching, whereby formulary changes or incentives for pharmacists and physicians can compel a stable patient to switch from his or her current medication to a less expensive treatment, regardless of health factors.
- Narrow networks and limited health plan coverage for support services such as physical or speech therapy, which can complicate a patient’s access to necessary care.
The paper’s authors acknowledge the importance of state legislation that addresses these barriers to care. They also emphasize the need to engage with public and private health plan leadership to ensure that the physician’s voice informs policies and protects patients’ access to the treatments they need.
To learn more, read “Protecting Patient Access to Treatments for Neurodegenerative Diseases.”
