Last week, we looked at access to medicines in health insurance exchanges for HIV/AIDS, oncology, cystic fibrosis, mental health and multiple sclerosis. The analysis by Avalere Health presents data on access to medications for chronic conditions in exchange plans.
Today, we’re looking at five more conditions and how insurance benefit design – and practices like utilization management – can be a hurdle to patients with chronic conditions accessing the medicines they need. Utilization management can mean prior authorization, where your health care professional has to get approval from your insurance company, or step therapy, where you might have to fail first on older or less personalized medicines before the medicine you are prescribed is covered.
Allyson Funk Ally is a former senior director of public affairs at PhRMA focused on advocacy issues for the biopharmaceutical industry. Her expertise includes Medicare, Medicaid, 340B, health reform and more. Prior to PhRMA, her experience included leading health communications for a large membership organization, supporting public affairs clients and working for the governor of Louisiana.