Week in Review: The Obstacles to Patient Care Under HIX

Week in Review: The Obstacles to Patient Care Under HIX

06.13.14 | By

For our nation’s most vulnerable patients, access to necessary medicines to treat and even cure the diseases they are battling every day is critical. Improved patient health relies on the innovative treatments, and this week we focused on the importance of ensuring those medicines make it into the hands of patients in need.

For some patients, accessing these medicines is difficult given their current health care plans. On Wednesday, our President and CEO John J. Castellani joined several patient groups at the National Press Club to release new research by Avalere Health highlighting the significant burden that some Health Insurance Exchange (HIX) plans place on America’s patients. According to the data, more than 20 percent of Silver plans (the most commonly used HIX plan among patients) require patients to pay 40 percent or more out-of pocket for medicines used to treat chronic conditions such as cancer, HIV/AIDS and multiple sclerosis. These out-of-pocket expenses place a tremendous burden on chronically ill patients whose health depends being able to get needed medicines. These findings go hand in hand with the Milliman Client Report findings that we issued last month on the access barriers to Silver plan enrollees.

In conjunction with the release of PhRMA’s new Affordable Care Act (ACA) webpage, PhRMA’s Robert Zirkelbach highlighted three charts to further demonstrate the impact of HIX plans for patients. Among them was the shocking finding that many prescription medications for chronic disease patients are not covered under 46 percent of Silver HIX plans until patients meet their (often high) deductibles. This means patients may be forced to pay thousands of dollars out-of-pocket before their coverage even goes into effect or, unfortunately, not fill their prescriptions at all.

These high hurdles put patients in a difficult situation that could significantly damage their health and the economy. Medication non-adherence due to high-cost treatments can often lead to unnecessary and expensive hospitalizations and follow-up appointments for patients. This week, our Conversations forum asked experts to weigh-in on how patients with chronic conditions under HIX coverage are affected by high out-of-pocket costs for much needed treatments, and their responses shared a common theme: It’s time to put our patients first. High costs restrict access and lower the quality of life for our nation’s most vulnerable patients. Read the expert responses and join in the conversation here.

Patient access to needed treatments is vital to their health and the health of our economy. We encourage you to learn more about the ACA and HIX through our new ACA webpage, and help us keep the discussion going on Facebook and Twitter. Also, keep an eye out for a new Medicines in Development report next week to learn more about what is in the pipeline to further benefit patients.


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