Access to Safe, Effective and Affordable Medications and Treatment Options

Stabilized treatments are necessary for patients with chronic conditions and access to medications is critical however patients are challenged by practices including prior authorization requirements, limited and changing drug formularies, and specialty tiers and co-pay accumulators that shift costs to patients. Lack of access to affordable medicines has led to patients not filling a doctor’s prescription, reducing the dosage to make a supply last longer, buying medicines from foreign countries or substituting alternative therapies.

STEP THERAPY (“FAIL FIRST”)

Step therapy is a practice health insurance plans use to manage the cost of medications. These insurance policies require the least expensive drug to be prescribed to a patient first, rather than the medicine originally prescribed by the doctor. This practice can result in serious negative consequences for consumers and the public health system. By limiting the medication options, both doctors and patients are forced to compromise their treatment decisions in a way that is dangerous, time consuming and more expensive in the long-term. Asthma medications are especially prone to step therapy because health plans frequently change the list of preferred medicines they will cover. Therapies prescribed by a healthcare provider are centered around patient care, and shared decision-making follows after the patient and provider establish a trusted relationship. When insurers interfere in this process any change in the course of treatment can jeopardize a patient’s well-being.

NON-MEDICAL SWITCHING

Non-Medical Switching occurs when patients on stable therapies are switched off their medication by their health insurers. This is done by:

  • Assigning a higher co-pay to the medication;
  • Increasing patients’ out-of-pocket requirements;
  • Reducing the maximum plan coverage amount for prescription medications;
  • Eliminating coverage for certain medications; and
  • Formulary changes for non-medical reasons.

Every patient is unique, and it can take years for patients and their doctors to find the right treatment, particularly patients with chronic conditions like asthma or severe allergies. These patients rely on a stable medication regimen to live healthy and experience no or minimal impact to their quality of life.

Unexpected changes in medications can lead to a return of symptoms, increased healthcare costs, and even death. In the cases of asthma and allergies, important considerations about appropriate therapy not only related to the medication selected, but also the delivery device that is used. It is important for patients and their physicians to remain in control of treatment decisions, rather than an insurer, government, pharmacy or other third parties.


Learn more:

Understanding Non-Medical Switching

Patients with chronic or serious medical conditions must sometimes work with physicians for months to identify a medication that’s effective for them.

Access to Asthma Medications

Because of asthma, 26 million Americans struggle to breathe, exercise, and go about their daily lives. But increasingly, they also face another challenge: accessing their medications.


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