Cardiovascular Disease Resources
Cardiologist Seth Baum, MD, describes a hypothetical patient with a family history of extremely high cholesterol. “He’s not the typical cholesterol patient,” Dr. Baum explains, “And the typical medications, known as ‘statins,’ don’t lower his cholesterol enough.”
For many patients with complex, chronic conditions, the process of identifying the right combination of medications takes considerable effort. Imagine then how patients feel when their insurance company forces them to change their medication on the basis of cost.
The story has become a familiar one. A patient with a chronic condition works with his or her doctor to find the right treatment. The condition is stabilized, manageable.
But then that stable patient is driven by the insurance company to a drug that’s less expensive. The switch prioritizes insurers’ profit over patients’ health. And it often comes with consequences: new side effects, re-emerging symptoms that had been under control, or interactions with medication the patient takes for other conditions.
Now, for the first time, a national study puts data points behind the story – providing a clear, measurable look at the qualitative impact of non-medical switching. This report details the findings of two in-person focus groups as well as a national poll of 800 patients who experienced non-medical switching firsthand.
Not everyone can afford the medication they need. To make drugs more accessible, manufacturers sometimes provide co-pay coupons to help patients cover their out-ofpocket pharmacy expenses.
Manufacturers have issued co-pay coupons since the mid-2000s, but they have become more common in recent years. The amount of prescriptions paid for using coupons reached 19 percent in 2016.
Most drugs that have co-pay coupons don’t have lower-cost generic alternatives. For the few that do, these alternatives may not suit the unique characteristics of a patient’s medical history or disease state. Or, a patient has already tried the less expensive option and found it ineffective.
Regardless of what may be available, doctors should be trusted to prescribe the most appropriate medication for their individual patients. And when a doctor prescribes a costly regimen, until recently, patients could depend upon co-pay coupons to count toward their yearly out-of-pocket deductible. Many patients relied on this arrangement to access their medications.
Yet for patients across the country, that reality is changing.
The scope of cardiovascular disease’s cost, both financial and in human suffering, should not be underestimated. Heart disease costs the United States an estimated $30.7 billion per year. And the situation is only going to grow worse: The American Heart Association projects that 40.5 percent of the U.S. population will have some form of CVD by the year 2030.
The good news is that cardiovascular disease sits at the apex of priorities for the U.S. healthcare system. As a result, patients and physicians have access to a range of effective and time-tested treatments, such as statins, beta blockers and ACE inhibitors, as well as life-changing devices, such as pacemakers. Over the past few years, treatment options have expanded further to include significant new therapies that can help more patients gain better control over their symptoms, experience fewer side effects, and live longer lives with conditions like heart failure, high cholesterol and high blood pressure.
But obstacles threaten patients’ access to both new options and old, dissuading or outright preventing them from obtaining the best therapy or device. That’s because healthcare concerns are trumped by decisions based on short-term benefits. But by carefully advocating long-term solutions backed by experts—the physicians and providers on the front lines treating cardiovascular disease—we can radically improve the heart health of our nation.
An attitudinal survey of more than 350 heart disease patients, providers, caregivers and stakeholders revealed widespread concerns about how health plans delay access to life-saving medication. The issue affects a broad swath of the country. One-third of Americans have high LDL cholesterol, putting them at increased risk for heart disease, the leading cause of death in the United States. Meanwhile, one American has a heart attack every 40 seconds. For these people, unreasonable medication delays caused by prior authorization or step therapy can be serious, even life threatening.