A Study of the Qualitative Impact of Non-Medical Switching

A Study of the Qualitative Impact of Non-Medical Switching

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.

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Improving Access to Respiratory Care

Improving Access to Respiratory Care


Respiratory illnesses are pervasive, chronic conditions that exist quietly in millions of Americans. Patients manage their breathing with varying degrees of success, since the ability to keep on top of symptoms depends heavily on a patient’s personal circumstances. 

Paradoxically, respiratory health rarely gets the policy attention it deserves. The current health care paradigm is one of disease treatment, rather than disease prevention. Though prevention is the cornerstone of good respiratory health, the United States has fallen behind in addressing health care delivery for day-to-day treatment of chronic conditions. 

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Overcoming Barriers to Dermatological Treatment

Overcoming Barriers to Dermatological Treatment

Skin is an organ like no other. It can be seen and touched; it is instantly visible on ourselves and others. And in addition to dictating much of our outward appearance—which has vast social significance—our skin allows us our sense of touch and serves as armor protecting us from hostile environments and microbes. 

Just as skin serves multiple functions, conditions impacting our skin can have a multifaceted impact. People who have skin conditions may experience feelings of isolation due to how the appearance of their skin is perceived. For patients with conditions like psoriasis or eczema that are connected to stress, these feelings can be doubly painful—isolation breeds stress, which in turn exacerbates the condition. Skin conditions can undermine a patient’s ability to function at work, school, home, or other social situations, meaning they can have a serious impact on a patient’s financial security and emotional stability. 

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Physician's Perspective: Asthma & Non-Medical Switching

Physician's Perspective: Asthma & Non-Medical Switching

Asthma’s prevalence has more than doubled in recent decades, yet the disease remains highly individualized. Patients’ triggers, the severity of their symptoms, their ability to manage their condition, and their success with different treatments and delivery mechanisms varies.

While clinicians recognize this fact, health plans may not. Insurance coverage models too often embrace a one-size-fits-all approach that generalizes care based on rigid disease-state algorithms that prioritize the lowest-priced treatment options. The approach incorrectly assumes that patients are interchangeable, and that children are just small adults.

Increasingly, insurance companies and even pharmacies may drive changes in asthma medication or delivery device that are unnecessary, expensive and even dangerous for patients.

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Physician's Perspective: Co-Pay Accumulator Adjustment Programs

Physician's Perspective: Co-Pay Accumulator Adjustment Programs

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.

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Improving Access to Cardiovascular Care

Improving Access to Cardiovascular Care

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.

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National Survey of Attitudes Toward Cardiovascular Treatment & Access

National Survey of Attitudes Toward  Cardiovascular Treatment & Access

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.

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Protecting Access to Diabetes Care

Protecting Access to Diabetes Care

Almost 1 in 10 Americans – men, women, and children of all ethnicities and income levels – has diabetes. One of the most common medical conditions in America, diabetes has become more widespread in recent years, increasing by more 1 million people between 2012 and 2015 alone.

Not surprisingly, diabetes is an expensive disease. In 2017 diabetes cost the United States $237 billion in direct medical costs and $90 billion in reduced productivity, accounting for about one in every four health care dollars spent. People with diabetes incurred an average per-patient cost of $16,750 a year.

Diabetes’ impact and prevalence demand policies that allow people to access appropriate medications and effective health care.

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