Patient access to treatment should be determined exclusively by clinical decisions, not economic decisions.
The Invisible Middlemen.
Pharmacy benefit managers (PBMs) are companies hired by insurers to manage drug benefit programs. They essentially act as middlemen between insurers, manufacturers, and pharmacies and thus have a uniquely central role in the drug market, handling everything from setting patient copayment amounts to determining which drugs are covered by which health plans. However, while they claim to reduce costs, the lack of transparency in their methods makes this claim difficult to prove.
Categorized as a spectrum disease, ranging in frequency, severity and duration. Some people with migraine disease may experience as few as 1-2 attacks a year while others have 15 or more migraine days per month.
There are new treatments on the horizon that are being specifically developed for migraine. We will keep you updated about: how/when they come to market and any obstacles to access that may arise.
A new class of drugs for patients in need of cholesterol lowering treatments.
PCSK9 inhibitors are a new class of drugs that hold promise for patients who have not responded to traditionally used cholesterol lowering drugs. Unfortunately, access to PCSK9 inhibitors has been challenging, with some reports stating that only one third of patients actually get the drug after they have received a prescription for its use.
Insurers and PBMs are restricting access and making patients shoulder more costs with discriminatory plan design
Help support bills that limit patients’ costs for specialty tier drugs. 87% of stand-alone Medicare Part D Prescription Drug Plans and 98% of Medicare Advantage-Prescription Drug Plans use specialty tiers, and this can be very expensive for those in need of special medicines.
Delaying access to required treatments.
Prior authorization is a system insurance companies use to contain health care spending. Insurance companies apply prior authorization procedures to certain high cost medications.
When a patient has to fail first on a drug before being allowed to take the medication originally prescribed, the patient, physician and public health suffers.
Fail first or step therapy is a common practice among insurers. It can be a rational, science-based process to ensure that patients receive the best treatments at the lowest cost to them. However, it can also be used to generate substantial insurer profits, at the harm of patients’ health.
A new class of treatments that can help lower healthcare costs.
With expanding demand for good-quality healthcare, comes the challenge of controlling healthcare costs. The safe and regulated introduction of biosimilars into the market has been forecast to increase and improve access to much needed biologic medicines and reduce costs.
The FDA uses advisory committees to provide independent expert advice to the
August 15th, 2019
Norman Sharpless, MD
August 13th, 2019
The Honorable Alex M. Azar II
Secretary U.S. Depart
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