Patients Deserve More than Aspirin

Patients Deserve More than Aspirin

07.03.12 | By Greg Lopes

What if we had stopped innovating after discovering aspirin? Certainly we wouldn't have had the dramatic improvements in health outcomes that we've seen over the last hundred years. Over the years, medicines have played a key role in significantly reducing deaths, with major advances in treatments for heart disease, many cancers, and HIV/AIDS.

That's what I think of when I see shortsighted steps taken in the name of cost cutting. Harris Meyer with Kaiser Health News gives us an example of this type of decision making in his article, "Wash. State Insurer, Official Clash over Drug Coverage Cutbacks."

To summarize Mr. Meyer's story, Premara, a health insurer in Washington, decided to eliminate brand-name drug coverage from its LifeWise health plans in the individual market, offering only generic drug coverage. This prompted Insurance Commissioner Mike Kreidler to issue an emergency rule barring generic-only coverage. He said patients with conditions such as multiple sclerosis and cancer can't necessarily be treated effectively with generics. Premera reacted by eliminating all drug coverage from its Lifewise plans.
Kreidler spokeswoman Stephanie Marquis said Premera's elimination of drug benefits was part of its effort to "get rid of high-cost patients."

Discrimination in health plans is not right. We think it is critical that benefit designs do not discriminate against high-cost/high-risk patients, who often have debilitating conditions and are in need of the most effective treatments.

It is particularly important to assure that drug plan formularies include a broad range of treatment options for conditions that disproportionately affect vulnerable individuals - for example, patients with mental illness, HIV/AIDS, and cancer. And, coverage should include the brand and generic options necessary and appropriate for the prevention, treatment, and management of disease.

Premara's decision is not only discriminatory - it may very well backfire in the long-term. Medicines can improve patients' conditions and help them to avoid other costly medical care, as has been shown by a growing body of research.

Let's look at this from a big picture perspective. The examples of landmark improvements in the ongoing fight against disease would not be possible without new, brand-name medicines. Without breakthrough treatments, many patients would die or need to resort to expensive hospital care.

Following Premara's path would be disastrous to patients - and could exacerbate rising health care costs. Without access to new medicines, we'll ultimately be fighting disease solely with generics, bringing innovation to a standstill. So, again - imagine if we'd done the same thing one hundred years ago and stopped innovating after aspirin.

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