New highly anticipated treatments are in the pipeline for respiratory patients and could soon be up for approval before the Food and Drug Administration as reported in a recent blog post from the Alliance for Patient Access titled “Will Insurers Come through for Respiratory Patients?” The underlying question on most people’s minds, however, is what type of barriers will patients face in getting their insurers to pay for the new treatments once they are approved?
The Alliance for Patient Access is a national network of physicians dedicated to ensuring patient access to approved therapies and appropriate clinical care. The AARC is a member of the Alliance’s Respiratory Therapy Access Working Group which several years ago published a White Paper on “Improving Access to Respiratory Care” which details the most pressing access barriers facing patients suffering from respiratory health conditions together with related proposed solutions.
The blog highlights delay tactics by insurers commonly referred to as “new-to-market exclusions.” This is a situation in which patients are told they must wait a few months or until the medications can be added to the insurers’ approved list. It is reported that this tactic has increased 160 percent between 2014 and 2018. Prior authorization is another tactic that can result in delays due to onerous paperwork requirements needed to gain coverage. This is a disturbing trend that could impact those with chronic respiratory disease from getting the types of medications that can improve their health and quality of life.
We encourage our members to read the blog to learn more about the issue.
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