The introduction of a new treatment is a boon for any disease state. But what happens when health plans use the availability of new treatments to actually reduce patients’ choices?
Patient advocates and health care providers are concerned that insurers will use the advent of new biologic therapies for uncontrolled asthma to do just that.
Biologic therapies, medicines derived from living cells or systems, were traditionally administered in a health care provider’s office. A new therapy for uncontrolled asthma, however, would allow patients to administer the medicine themselves at home. The advance is exciting for patients, who may now choose between getting their treatment at home or in their physician’s office. But health plans may see a different sort of opportunity.
The availability of multiple therapies gives insurers more leverage to negotiate with manufacturers. But while price competition is important, health plans may seize the chance to drive all patients to the medication that offers insurers the best deal – regardless of individual patient needs, preferences and health history.
Health plans looking to boost profits could require step therapy, for example. This might mean requiring patients to try and fail on the self-administered medication before getting coverage for the physician-administered drug. The requirement could be tough for patients who feel more comfortable having a health care provider administer the medicine in a medical setting.
Another tactic is non-medical switching. Here, patients who are already stable on one therapy for severe asthma could get pushed to another based on which drug has the biggest financial gain for the insurer. As research has shown, non-medical switching can have financial effects downstream as well as a far-reaching negative impact on patients.
“Asthma is nuanced,” explained Tonya Winders of the Allergy & Asthma Network. “Each patient’s experience with asthma is different, as is his or her response to treatment. Taking a one-size-fits-all approach with these patients raises serious concerns.”
Access challenges could also undermine the role of the clinician-patient relationship. “People living with asthma look to their health care provider as a partner in managing this disease and choosing the most appropriate treatments,” explained allergist and immunologist Allen Meadows, MD. “It’s inappropriate for a health insurance company to insert itself into that relationship.”
As patients, advocates and health care providers can attest, managing asthma well can mean better patient health, fewer ER visits and greater productivity for people living with the disease. In evaluating the costs and benefits of new treatments, insurers would be wise to take these facts into consideration.
