By Abbie Cornett
As the patient advocate for IG Living magazine and a common variable immune deficiency (CVID) patient, I want to educate myself and our readers about the issues that affect access to care for patients with rare and chronic diseases. While I have been involved with the patient community for many years, the issues continue to change. Therefore, to learn how these issues evolved and how they impact our care is paramount. One of the best ways to keep in touch with the concerns of patients is to reach out to the different advocacy groups to find out how they are being impacted by current policy and what they are doing to protect their constituents.
With that goal in mind, I registered for and attended a webinar put on by the California Chronic Care Coalition (CCCC) on August 8. Titled “Ensuring People with High Risk Chronic Conditions/Diseases Have Access to Affordable Specialty Medications,” the webinar featured two nationally recognized speakers: Brenda Gleason, the president and founder of M2 Health Care, a recognized expert on healthcare policy and author of What We Don’t Want to Hear About Health Care, and Wayne Turner, staff attorney for the National Health Law Program.
Brenda Gleason discussed how the system of specialty tiers affects patients and their families by limiting a patient’s access to care and placing an undue financial burden on the chronically ill by switching patients from a system of copay to coinsurance. She explained that the insurance companies have created a tiered cost-sharing mechanism, and under this mechanism, health plans require beneficiaries to pay copayments or coinsurance, with rates varying based on the health plan’s drug tier. These tiers have increasing levels of cost sharing, which can result in the patient paying between 20 percent and 30 percent of the cost of the medication. The patients with the most expensive medications are placed in the highest tier.
The tiered system creates a barrier to care for patients with chronic diseases by making their medication prohibitively expensive — a policy that can be counterproductive to the goal of cost savings by forcing patients to be non-adherent to their prescribed therapy, leading to increases in hospitalizations. It also creates a potential issue of discrimination against the chronically ill under the Affordable Care Act (ACA). Wayne Turner discussed this potential for discrimination, as well as a complaint filed with the U.S. Department of Health and Human Services. Turner explained that the safeguards built into the ACA prohibit discrimination based on a pre-existing condition and/or health status. Qualified health plans are also prohibited from employing marketing practices or benefit designs that discourage enrollment.
The webinar was very educational. It explained some of the issues facing patients today, and it highlighted efforts of the advocacy groups trying to protect the chronically ill. It is important to remember that the best advocates for patients are the patients themselves. It is imperative that we keep informed on current issues that impact our access to healthcare and our quality of life.
What are your thoughts on this topic?