Because of asthma, 26 million Americans struggle to breathe, exercise, and go about their daily lives. But increasingly, they also face another challenge: accessing their medications.
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.
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.
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.
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.