News & Media
Report Card Finds Top Health Insurers and PBMs Imposing Significant Restrictions on Patients with Autoimmune Disease
New National Initiative Established to Advocate for Doctor-Patient Led Decisions vs. Harmful “Step Therapy” Interventions
As policymakers in Washington consider proposals that would expand the use of step therapy within Medicare Part D’s “six protected classes” and Medicare Part B, the report card released today demonstrates how the vast majority of private and Medicare health plans, including AARP Medicare Rx Preferred, Humana Walmart Rx Plan, Blue Cross Blue Shield Federal Employee Plan Standard and others, impose significant to severe restrictions on access to the most appropriate medicines for the diseases evaluated in the study. According to the findings, 86% of Medicare Advantage and Part D plans received an “F” for access to medicines at the pharmacy. All plans within Medicare Advantage and Part B received an “A” for access to medicines that are administered in a doctor’s office.
The five autoimmune diseases studied do not fall within Medicare Part D’s “six protected classes,” however, the findings show how coverage for drugs within these therapeutic classes may changes if reforms are enacted. Patients who need medicines that fall within the “six protected classes” may see higher access restriction (similar to Part D). Furthermore, the “A” grade that Part B plans received would be jeopardized if step therapy were expanded and physician-administered drugs were treated more like Part D – as outlined in one of the Administration’s proposals.
“We are bringing critical attention to step therapy and other restrictive practices that undermine the doctor-patient relationship and give insurance companies the ability to make treatment decisions,” said Randall Rutta, Chair of the Advisory Task Force, Let My Doctors Decide. “When recommended by doctors for medical reasons, step therapy can be the right choice. However, there is an important
distinction between sound medical protocol versus economically-driven decisions that do not take into consideration what is medically best for the patient.”
Let My Doctors Decide is driven by an advisory task force of patient advocacy and provider groups led by the American Autoimmune Related Diseases Association. The expanded task force includes the American Behcet’s Disease Association, American Gastroenterological Association, Coalition of State Rheumatology Organizations, Dermatology Nurses Association, International Foundation for Autoimmune and Autoinflammatory Arthritis, Lupus Foundation of America, National Organization of Rheumatology Managers and Sjögren’s Syndrome Foundation.
To read the full results of the report card and learn more about this new initiative, visit letmydoctorsdecide.org.
About Let My Doctors Decide
Let My Doctors Decide is a national partnership of leaders across health care working in support of a simple goal: treatment decisions should always be made by patients and trusted health care professionals, not insurance companies or pharmacy benefit managers.