Let My Doctors Decide are advocating for patient-provider partnership in treatment decisions and addressing step therapy issues.
Patients and providers need to be team leaders in making treatment access decisions for patients, especially as both observe negative ramifications of step therapy and other prior authorization and utilization management strategies, according to patient advocacy group Let My Doctors Decide (LMDD).
The group, which recently unveiled a new set of guiding principles for payers and pharmacy benefits managers (PBMs), asserted that utilization management strategies like step therapy can be detrimental to patient health, and instead they should take a more patient-centric approach.
Specifically, LMDD stated that step therapy creates undue access limitations on the patient, keeping a patient from getting ahold of critical medications in a timely manner. This can be especially problematic for patients with autoimmune disorder who LMDD represents.
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This week at the American College of Rheumatology Annual Meeting in Georgia, LMDD unveiled new Patient Principles, which the group is urging payers and PBMs to sign onto in an effort to create a more patient-centric healthcare experience.
“Strong clinician-patient relationships are essential to achieving positive outcomes for patients and facilitating a more workable system for all health care stakeholders,” said Randall Rutta, executive director of LMDD. “Our Patient Principles are based on the firm belief that treatment decisions should always be made by patients and trusted health care professionals, not insurance companies or pharmacy benefit managers.”
Foremost, the principles call for patients and providers to partner to make individualized patient treatment decisions, as opposed to a one-size-fits-all approach to patient treatment access.
The Patient Principles also call for better patient education about specific treatment options, arming patients with the knowledge necessary to make an informed decision. Patient education is crucial to shared decision-making and the partnership between patients and providers in choosing a treatment method.
Key educational information may include out-of-pocket patient costs after insurance coverage and rebates, as well as how to get the necessary treatment approved by a payer.
Finally, the Patient Principles call for better rebates and drug discounts to be passed onto the patient at the pharmacy counter, helping to chip away at the astronomical out-of-pocket costs that plague patients across the country.
These guiding principles come as many in the medical industry are focusing on step therapy, prior authorizations, and other utilization management tactics that can impact patient access to care. Utilization management strategies aim to connect patients with costly medications only when patients truly need them and after lower-cost options have been exhausted.
While there is some merit in attempts to cut healthcare costs, many experts assert that these tactics can keep patients away from necessary medications, at least from some time.
Ninety-one percent of doctors say that prior authorization and utilization management gets in the way of timely patient care access, according to a 2019 survey from the American Medical Association (AMA). Sixty-five percent said they have had to wait at least one business day to hear back from an insurer about a prior authorization decision. Twenty-six percent said they have had to wait at least three business days.
And that wait can be disastrous for patients with certain time-sensitive or serious medical conditions.
Twenty-eight percent of the survey’s 1,000 physician respondents said prior authorization requirements have led to serious or life-threatening health events. Ninety percent of respondents said prior authorization has negative consequences for patient care quality.
This latest statement from LMDD echoes other industry calls to end prior authorization, step therapy, and utilization management principles, or at least to reconfigure those requirements.
Again, there is value in assessing whether a lower-cost medication will help address a patient’s disease, but the process must be patient-centered and take into account certain patient circumstances that can impact the step therapy or prior authorization process.
LMDD’s statements also take a step further, asserting that drug pricing and patient billing need to be based in patient-centricity. Drug prices are exceptionally high and becoming out of reach for many patients. Addressing these issues, driving price transparency, and helping patients and providers to make informed treatment decisions will be critical.
Source: Patient Engagement Hit