Deceptive insurance practices that block medical treatment access need reform
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Chronic illnesses continue to burden communities across Louisiana, and patients living with these conditions need consistent access to the treatments they are prescribed.
However, onerous insurance policies and other barriers to care are making it more difficult for patients to manage living with a chronic condition by delaying or blocking medication access.
Over 2 million Louisianians are living with a chronic illness, such as hypertension, diabetes, and arthritis. For these patients, uninterrupted access to provider-recommended treatments is essential to staying healthy, actively participating in the work force, and being able to maintain daily routines.
Yet, health insurers and other industry middlemen continue to impose new policies that are intended to contain costs for insurers but disrupt critical health care coverage and leave patients without treatment access.
Under a new program growing rapidly in popularity, third-party, for-profit vendors known as alternative funding programs (AFPs) approach smaller companies with self-funded health insurance plans and encourage them to drop coverage of certain medications to save money on insurance premiums. In this scenario, AFPs take on the responsibility of finding “alternative funding” for these often high-cost and specialty treatments so the patient gets the medicine they need.
Once a medication is dropped from a health plan, a patient covered under that plan is no longer insured for the treatment. AFPs work to gain access to the treatment for the patient who is now considered “uninsured.”
AFPs then help patients obtain medications through patient assistance programs, such as those operated by pharmaceutical manufacturers, governments, or independent charitable foundations, which are intended to serve vulnerable, uninsured, or underserved patient populations.
AFPs are a growing concern in the health care delivery system. By taking advantage of needs-based assistance, AFPs divert funds away from programs intended for vulnerable patients, resulting in fewer resources for patients who truly depend on such programs.
Additionally, AFPs can lead to significant delays in treatment access, or even block access completely, for patients living with chronic conditions. An assistance program may detect that a patient is being disguised as uncovered or uninsured and reject their application for needs-based assistance, leaving patients without coverage or access to their treatment.
Disruptions in treatment coverage can have significant consequences on patient health, increasing the likelihood of severe symptoms and hospitalizations and leading to even larger economic strains on Louisiana’s health care system.
My son Max lives with severe hemophilia A with inhibitors, a condition where he can lead a normal and successful life so long as he can maintain his prescription treatment regimen. Should the health plan that we rely on to access and afford his treatments begin working with an AFP, Max could lose access to the treatment plan that works for him – when he’s already had to try different medications and visit several doctors to identify the right plan for him.
Many Louisiana patients can already face different barriers in accessing health care, such as high costs at the pharmacy counter and having to travel long distances for care, and AFPs are just another hurdle that patients, particularly those living with chronic conditions, are having to navigate.
More than 1,400 Louisianians have acknowledged that they already face challenges confidently navigating the health care system and understanding their cost-sharing obligations. Lawmakers should not allow more industry middlemen complicate an already convoluted system and profit off of vulnerable patients.
Thankfully, the Louisiana State Legislature is considering legislation that would assure Louisiana patients can continue accessing the treatments they rely on. House Bill 509 would prohibit any insurer or third-party entity from altering or changing the conditions of a health benefit plan as a result of other financial assistance being available for a prescription drug, such as charitable patient assistance programs.
This legislation would ensure that insurers are not passing off the responsibility of covering stated benefits to other entities or to the patient and will protect the viability of programs intended to help uninsured patients access their treatments.
Over 30% of health plans are considering using AFPs and 8% are already using them. Louisiana patients need policies that will improve their access to health care, not restrict it.
The post Deceptive insurance practices that block medical treatment access need reform appeared first on Louisiana Illuminator.
