Monitoring patients with a genetic heart condition can prevent hospitalization and even sudden cardiac death. So, why would insurers not cover the tests necessary to avoid that?
In many cases, it’s because they are not familiar with an FDA-required drug safety program called Risk Evaluation and Mitigation Strategies. The program is used to monitor patients who take medications that could have serious safety concerns – to ensure those risks don’t outweigh the benefits.
Such is the case for a novel class of hypertrophic cardiomyopathy treatments: myosin inhibitors.
Imaging Monitors Underlying Condition and Treatment Effectiveness
The treatment can improve the heart’s functional capacity and reduce the need for costly surgeries for patients living with HCM, which causes a thickening of the heart muscle and impedes heart function and blood circulation.
Hypertrophic cardiomyopathy can mimic more common heart conditions, making it difficult to diagnose. Once it is identified, however, ongoing imaging via echocardiogram is necessary for continued disease monitoring. That same imaging is also necessary to look for signs of treatment-induced complications.
This above-average number of imaging orders is likely to trigger prior authorization and reauthorization requirements that impede continuity of care.
Delays Contribute to Worse Patient Outcomes, Provider Burnout
The repetitive process and delays caused by insurers’ lack of awareness around REMS protocols are frustrating, according to Lori Jarosch, a certified physician assistant from Grand Rapids, Michigan.
“If insurance companies were more familiar with guidelines relative to hypertrophic cardiomyopathy,” Jarosch asserts, “the endless rescheduling, canceled tests and undue stress could be prevented.”
Jarosch’s frustration is felt by most clinicians. Nine in 10 physicians report the excessive paperwork also impacts their ability to provide the best care to patients and leads to burnout.
Reforming authorization requirements could allow providers to offer, and patients to receive, better care, reducing both future costs and the human toll of hospitalizations and preventable deaths from hypertrophic cardiomyopathy.
