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NAPF RECOMMENDS PATIENTS RECEIVE EASILY ACCESSIBLE AND UNDERSTANDABLE METHODS TO APPEAL DUR POLICIES, INCLUDING STEP THERAPY REQUIREMENTS.
Hemophilia Federation of America (HFA) issued a statement in 2016 that decried step therapy practices for hemophilia patients, citing that the risks of factor product changes far exceeded the bene ts of any cost savings. HFA further stated that physicians, not payers, should hold treatment decisions.14
The National Patient Advocate Foundation (NAPF) policy recom- mends patients whose conditions are well managed on a given therapy be protected from unreasonable cost-sharing methods from existing health insurance plans and through
any transition to a new health insur- ance plan. NAPF also recommends that patients receive easily acces- sible and understandable methods to appeal DUR policies, including step therapy requirements.15
Several professional organizations, including the American Academy of Dermatology and the Florida Society of Clinical Oncology, have joined pa- tient advocacy groups to voice their concerns to state legislators. Some states have implemented laws that impact step therapy protocols, yet no state has revoked step therapy or DUR processes.
Reducing costs, increasing ef cacy of medications and ef ciencies in services are necessary elements of U.S. healthcare, as are investments in research and delivery of innova- tive medicines to market. Healing people, however, remains the pri- mary purpose of the U.S. healthcare industry. As the era of patient-cen- tric care and personalized medicine approaches, all industry stakehold- ers can bene t from remembering the health of people is what drives our industry.
Sources
1 Center for Disease Control and Prevention, Health, United States, 2015, accessed January 2017 at cdc.gov
2 J.D. Kleinke, The Price of Progress: Prescription Drugs In The Healthcare Market, September 2001, accessed January 2017 at healthaffairs.org
3 Frank D. Lichtenberg, Benefits and Costs of Newer Drugs: an update, June 2007, accessed January 2017 at onlinelibrary.wiley.com
4Academy of Managed Care Pharmacy, Drug Utilization Review, April 2008, accessed January 2017 at amcp.org
5David Charles, MD, Understanding Step Therapy, 2015, accessed January 2017 at accc-cancer.org
6Jeffery Bendix, MA, The prior authorization predicament, July 8, 2014, accessed January 2017 at medicaleconomics.modernmedicine.com
7Express Scripts, Step Therapy, The Right Medicine at the Right Cost (patient brochure, 2009), accessed January 2017 at amhic.com
8Tony Barrueta, SVP, Government Relations, A Brief History of Drug Pricing, May 15, 2015, accessed January 2017 at achp.org
9National Patient Advocate Foundation, Issue Brief: Utilization Review, updated April 2015, accessed January 2017 at cqrengage.com
10 Justin McDaniel, Step Therapy in the States, December 15, 2016, accessed January 2017 at knowledgecenter.csg.org
11 Bob Tedeschi, Are insurance policies saving patients money, or keeping them from the treatment they need? August 22, 2016, accessed January 2017 at statnews.com 12 Jennifer Hinkel, Life, Death, And Money: The Hidden Economics of Cancer, June 28, 2016, accessed January 2017 at blog.mcgivneyglobadvisors.com
13 Adrienne Chung, et al., Does A ‘One-Size-Fits-All’ Formulary Policy Make Sense? June 2, 2016, accessed January 2017 at healthaffairs.org
14 Hemophilia Federation of America, Issue Brief, Non-Medical Switching and Step Therapy, 2016, accessed January 2017 at hemophiliafed.org
15 National Patient Advocate Foundation, Issue Brief: Utilization Review, updated April 2015, accessed January 2017 at cqrcengage.com
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