As vacation season winds down, here’s a quick review of the health policy topics that impacted patient access this summer.
1. “Why don’t we take into consideration quality of life and independence?”
The mother of a child with Duchenne muscular dystrophy questioned how the Institute for Clinical and Economic Review evaluated new drugs for her son’s rare, and often fatal, disease. ICER’s determination that the treatments were not cost-effective came just weeks after a paper from the Pioneer Institute argued that ICER is fundamentally flawed in its approach to valuating rare disease drugs.
2. “Part D enrollees with high out-of-pocket drug costs spent over $3,200…”
The Kaiser Family Foundation released new data that underscored the need for out-of-pocket caps on prescription drug spending for seniors. An IfPA “Fast Facts” examines the issue.
3. “Improved insurance coverage and payment for different pain management modalities is critical…”
The final report from the HHS Pain Management Best Practices Inter-Agency Task Force reinforced the importance of balanced pain management. Weeks later, the Centers for Medicare and Medicaid Services announced it would add acupuncture to its cadre of covered services in certain clinical trials.
4. “Real people had real heart attacks and strokes because they could not get the medicine prescribed by their doctors.”
The FH Foundation’s Kelly Myers summarized a new study on how insurance rejections impact at-risk heart patients.
5. “Despite its impact, migraine is also under recognized, under diagnosed and under treated.”
The World Federation of Neurology used its World Brain Day to highlight the burden of migraine. While new migraine treatments continue to emerge, patients struggle to get the workplace accommodations and medical treatments they need.
6. “Business decision.”
That’s how insurers in Maine described their choice to make more than 300 drug formulary changes that resulted in non-medical switching and increased out-of-pocket costs for 80% of impacted patients. Insurers’ data reporting was a requirement of a state law on non-medical switching that passed last year. Other state legislatures are also taking up the issue.
7. “The elimination of access restrictions …would not only drive down prevalence of the disease…but also produce substantial savings…”
An American Journal of Managed Care study explained that direct-acting antivirals to cure hepatitis C also saved state Medicaid programs money. Advocates hope the findings may improve access for infected patients.
Follow the IfPA Policy Blog this fall for more videos, policy papers and insights on patient access. Welcome back!