Pharmacy and therapeutics committees decide which medications will be used or covered by hospital systems, state Medicaid programs, insurers and federal agencies.
Read MoreIndividual states sometimes establish prescription drug affordability review boards to explore ways to lower prescription medication costs for Medicaid patients and reduce the impact on the state health care budget. State legislators pass laws to create prescription drug affordability review boards.
Read MorePatients who rely on prescription medication may encounter bureaucratic delays, high out-of-pocket costs or forced medication switching. These hurdles often stem from the work of middlemen known as pharmacy benefit managers.
Read MoreThe Institute for Clinical and Economic Review is a health economics organization that assesses the value of new drugs, medical devices and diagnostics. Though ICER is not a government entity, its decisions often impact medication coverage by public and private health plans.
Read MoreWhat is the value of a new medication or medical device? The question is complex, and answers often vary depending upon who decides and which factors they prioritize.
Read MorePatients pay premiums for their health insurance coverage but also have to bear other costs when they use that insurance. The additional costs patients pay for their medical services and prescription drugs break down into three broad categories.
Read MoreTo get the medicine prescribed by their health care provider, patients must first prove that older, less expensive or insurer preferred alternatives don’t work. That’s the crux of step therapy, or “fail first.”
Read MoreFor 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.
Read MoreToday, approximately 12 percent of the global population experiences migraine attacks. And more than one third of these people have at least 15 migraine days per month.
More than “just a headache,” migraine is a hereditary neurological disease that affects people both physically and mentally. In addition to the pain of migraine attacks, the disease negatively affects patients’ ability to work, social relationships with family and friends, and the ability to provide basic self-care and to undertake normal life activities.
Read MoreCo-pay coupons are a common tool to help patients with chronic conditions cover the cost of expensive medications. Historically, co-pay coupons’ value has counted toward a patient’s annual deductible. Once the deductible is met, the patients pays a modest co-pay – a fixed amount – per prescription.
Read MorePatients can be denied access to their medicine for days, even weeks because of a practice called “prior authorization.” It’s the process whereby insurance companies must approve a physician-prescribed medicine, procedure or test before a patient can get coverage.
Read MoreThe 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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Read MoreImagine living with the debilitating pain of chronic migraine, the annoyance of excessive perspiration, or the embarrassment of involuntary neck twisting and jerking. Patients who experience these conditions may benefit from treatment with a biologic.
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