More than half of the patients declare a refused health insurance for drugs for chronic or rare diseases: survey

Diving brief:

• According to a new investigation.
• The survey of the health care defense group, the PAN Foundation, also noted a high prevalence of an economic tactic of employers called alternative financing programs, in which plans outsource access to high cost medicines instead of covering them by themselves.
• AFPs are a frequent target of patient defense organizations, which argue that they hinder access to medicines. In response to the survey, AHIP, the main hall for insurers, said that drug manufacturers were fixing the prices of prescription drugs at unaffordable levels, placing employers in a difficult location.

Diving insight:

Specialized medication spending, which dealt with rare, complex and chronic health problems, have soaked among the conditions of conditions and as the more expensive drugs enter the market. Although less than 5% of the population uses specialized drugs, drugs represent at least half of pharmaceutical spending in recent years, according to Carelonrx, the branch of health services of the insurer.

The increase in expenses on costly pharmaceutical products has led insurers to rely on use management controls such as previous authorizations to try to maintain costs. However, it is complicated access to patients who need specialized drugs, including in the plans sponsored by the employer, who cover the majority of Americans.

Fifty-four percent of adults covered by private plans were informed by their insurer that their medication was no longer covered, according to the PAN foundation survey among around 2,000 American adults in mid-July.

In addition, almost half of these adults said that their plan had referred to a third party to help them get medication, thanks to measures such as the importation of the drug from a different country or secure it through a patient assistance program from a drug manufacturer or charity.

Such AFPS saves health plans sponsored by employers because they do not have to cover expensive specialized drugs themselves. But AFP are controversial. The arrangements are often provided by for -profit companies that take advantage of it by keeping part of the money collected in assistance programs as a fee, according to the immune foundation.

The patient may have to accept restrictive conditions. And, any amount they pay for their medication through the program may not count for the annual limits for the cost sharing of the pocket, self -pertry patients with a higher financial burden.

AFP can also lead to delays in relation to simple insurance coverage. Among the patients who have chosen to work with an external company, more than third party have experienced a period of a month or more in the reception of their drugs – which has an impact on their mental and physical health, the worsening of downstream health needs and causing other challenges, said the PAN.

Almost all adults – 92% – said they had been negatively impacted by delays. And for many, the disturbance was not necessary. Almost half of the patients said that in the end, their drugs were again covered by their health insurance plan.

Amy Niles, director of the Pan Foundation mission, described the conclusions of “deeply disturbing” in a press release.

“The results of our research indicate how prevalent these practices are,” said Niles.

However, in an environment where pharmaceutical companies set ever higher list prices, employers may be forced to contract outside their plan to obtain alternative access to drugs that they simply cannot afford, according to insurance groups.

“No one has more control over the prices of prescription drugs than drug manufacturers. They alone have set prices-and they can lower them alone. However, they continue to increase prices year after year, increasing the premiums and direct costs for patients and employers,” said an E-mail spokesperson.

The cost increase is the concern of employers’ services n ° 1 this year, according to the consulting firm WTW. Estimates the way in which health care costs will increase for employers in 2025 vary, but generally vary from 6% to 9%, forcing them to move more costs on their employees.

Employers have written the increase in medical spending to factors such as inflation, higher negotiated prices for service providers – and specialized drugs.