By Amanda Conschafter, blog editor
“If you develop the most innovative products in the world, it doesn’t do the patients any good if they can’t access them.”
With these words, Bernadette O’Donoghue of the Leukemia & Lymphoma Society summarized panelists’ sentiments at the BIO Patient and Health Advocacy Summit discussion on “Preserving Patient Access to Innovative Treatments.” Participants overwhelmingly cited transparency as the foremost solution to patients’access challenges under health care exchange policies. These challenges –detailed by researchers, patient advocacy organization leaders and medical association professionals –include cost-sharing, narrowing provider networks and hard-to-decipher policy coverage information.
Leah McCormick Howard of the National Psoriasis Foundation added formulary and co-pay card restrictions to the group’s list of patient access barriers. She also noted that step therapy “delays the time for patients to get on the medication their physician thinks is optimal for treatment.”Patients managing psoriasis or psoriatic arthritis often need to change or combine treatments, Howard explained. Delayed or restricted access to one or more therapy options can disrupt their progress.
Emily Carroll of the American Medical Association detailed the effects of narrow provider networks. Some patients, she noted, delay or forego care when they discover that their exchange policy’s network doesn’t include the provider they need to see. Others opt for care out of network, which contributes to the ballooning out-of-pocket costs that many patients now battle. Carroll described AMA’s work to encourage quantitative measurements of network adequacy and to demand clear definitions of network plans through reform efforts.
But because formulary design, cost-sharing and narrow networks allow insurers to keep premiums low, Elizabeth Carpenter of Avalere Health explained, these features have quickly become a hallmark of exchange policies. Carpenter noted that deductibles in Bronze plans are roughly four times as high as those in traditional employer-sponsored plans. She also pointed out that more than 50 percent of bronze, silver and gold plans require coinsurance for specialty tier medicines.
As the federal exchange prepares to launch open enrollment November 15, consumers and patient advocates wait to see how network and formulary limitations, as well as cost-sharing and utilization management techniques, will shape 2015 policy offerings –and how patient access will fare as a result.