A group of health care and advocacy organizations is urging the Centers for Medicare & Medicaid Services (CMS) to expand coverage and access to semaglutide for the treatment of obesity. Doing so, the group says, could mitigate the detrimental outcomes and comorbidities that often develop as a result of obesity, a disease that places significant burdens on individuals and the health care system.
As lawmakers re-evaluate avenues to successful healthcare reform, they must not overlook the urgent need to protect the doctor-patient relationship. Expanded access to healthcare is meaningless unless lawmakers address third-party disruption in potentially life-saving medical treatments.
Read more at The Hill.
It's time for all those involved in the healthcare industry to reevaluate and reduce the administrative task burden placed on clinicians, according to policy recommendations from the American College of Physicians (ACP).
Read more at MedPage Today.
Just how hard is it to get insurance to cover PCSK9 inhibitor prescriptions? Two large claims databases showed about 80% of scripts were rejected on the first attempt.
In one analysis involving 44,234 new prescriptions for PCSK9 inhibitors in the QuintilesIMS databases from July 29, 2015, through July 15, 2016, just 17% of of the scripts were approved on the first attempt. With further paperwork, another 26% got approved, for an ultimate approval rate of 43%.
Read more at MedPage Today.
New health plan report card analyzes PCSK9 inhibitor claims for managed care organizations.
WASHINGTON – The Institute for Patient Access released a new Health Plan Coverage Report Card highlighting the rates at which California insurers deny patients coverage for advanced cholesterol-lowering drugs known as PCSK9 inhibitors. The report card reveals that health plans reject more than one out of every three claims submitted for coverage of prescribed PCSK9 inhibitors. The data, collected from July 2015 to July 2016 by a national data supplier, reflects PCSK9 inhibitor claims for California managed care organizations, including commercial plans, Medicare and managed Medicaid.
Key California Findings:
“This is a very troubling and frankly dangerous finding,” said Alliance for Patient Access Executive Director Brian Kennedy. “The patients prescribed this medicine have extremely high LDL cholesterol, and statins alone are not sufficient to reduce their risk of heart attack. With these new cholesterol-lowering drugs, patients’ risk of heart attack decreases, yet insurance companies are too often refusing to cover the medicine.”
PCSK9 inhibitors work by extending the lifespan of a receptor on the liver that clears “bad” cholesterol. Clinical trials data show that PCSK9 inhibitors can lower LDL cholesterol more than statins alone and can also reduce the associated risks of heart attack and stroke.
The Institute for Patient Access report card highlights the 18 California health plans that process the most PCSK9 inhibitor claims, ranking them based on the number of rejections issued. The least patient-friendly plans were the Federal Employee Benefit Plan, with a rejection rate of 84%, and Blue Shield of CA at 66%. Also denying claims at a far higher rate than the state average were Express Scripts, 64%, and Scan Health Plan, 52%. Humana Health Plan, Wellcare Management Group and Rite Aid had the lowest rejection rates, denying fewer than 30% of claims.
This report card is one in a series to be released by the Institute for Patient Access in 2017 to highlight barriers to patient access.
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BACKGROUND
