A new bureaucratic obstacle could make it even harder for asthma patients to get the medicine they need.
For several years now, high cost-sharing has stood between patients with severe asthma and immunotherapies such as mepolizumab and omalizumab. It may be a high deductible that must be fulfilled before health plans will pay their share. Or perhaps an insurer that’s placed the medication on a specialty tier, requiring patients to shoulder not just a flat co-pay but a hefty percentage of the drug’s total price.
Patients find themselves being asked to pay an amount that can rival their monthly grocery or utility bill. Some pay up at the price of personal sacrifice to themselves or their families. Others simply go without treatment.
But now, physicians who administer these medications in their offices are encountering access barriers of their own. The medications, which physicians inject via syringe, are shipped to physicians’ offices and kept in a climate-controlled environment until they’re used. A year or two ago, I would receive a two-three month supply in a single shipment. My staff would then keep the medication on hand to ensure that it was available and ready when patients needed it.
Today, the logistics are more complicated. Due to cost-cutting strategies devised by health plans and their pharmacy benefit managers, I receive “just-in-time” shipments. They arrive barely a day, maybe two, before I see the patient who will need the injection. And while a shipment once contained enough medication for a patient for three months, I might now receive a shipment with only a single dose.
Waste not, I agree. But when frugality stands to interfere with patients’ ability to access the medicine they need, I call that extreme. A hiccup in shipping could mean that I don’t have the medication a patient needs when he or she arrives at my office.
Not to mention that the red tape involved in providing these medications is multiplied under this new approach. Physicians and their staff must complete the necessary paperwork to obtain these medications more frequently. And patients bear the burden too. The litany of required questions – Do they still live at their given address? Do they still require the medication for the condition cited? – must be answered with each and every shipment request.
Worse, this obstacle materializes after a patient and physician have jumped through health plan hoops on the front end, such as obtaining the health plan’s prior authorization for treatment. First we must complete extensive forms, make phone calls, navigate the back-and-forth between physician and insurer just to get treatment approval. Then, physicians face the logistical hurdle of physically obtaining the treatment for their patients.
Advanced medicine is costly and should be handled with care, I agree. Some degree of due diligence is understandable. But how does this affect patients? I see no evidence that the health plans or pharmacy benefit managers imposing these policies are passing any cost savings to patients. More likely, patients are missing doses due to timing and shipping logistics issues. Some of my patients now get their injected biological every five-six weeks instead of every four weeks as is recommended.
That might save their insurer money, but it imposes a significant cost in terms of patient health.
Patients with severe asthma waited years for a medication that works. Yet now they find themselves either priced out of access or blocked by proceduralism.
These patients deserve better.
Allen Meadows, M.D., is a solo community-based practitioner at the Alabama Allergy & Asthma Clinic in Montgomery, Ala. He is chairman of the Alliance for Patient Access’ Respiratory Therapy Access Working Group.
