Helping to ensure patients have access to the medicines they need is a top priority for the biopharmaceutical industry. Over the past 15 years, biopharmaceutical companies have had more than 400 new medicines approved to treat patients with cancer, HIV/AIDS, hepatitis C, and other debilitating diseases. These medicines are transforming to lives of patients, enabling them to live longer, healthier lives, spend more time with their families, and pursue their passions. But the promise of medical innovation can only be achieved if patients have access to these treatments.
An increasing number of experts are raising concerns about insurance coverage of medicines and the barriers that patients face when trying to access the medicines they need. Here are some of their thoughts:
- “It’s going to cost more in the long run. They’re going to end up in the E.R, they’re going to end up sick, costing more money than if they took the drug. … It just breaks my heart to see. We’re finally making headway with treatments, and the insurance companies’ lack of foresight is going to change that.” – Patricia Ferland Weltin, executive director and founder of the Rare Disease United Foundation, told the Boston Globe.
- “If the deductible is very high, all of a sudden the financial protection part of insurance, you are losing that. You still have protection against very high claims, but you have people who may have to pay $5,000 during one year toward the cost of their care or more. And a lot of people don’t have that kind of savings.” – Paul B. Ginsburg, a professor at the University of Southern California’s Sol Price School of Public Policy, told the New York Times.
- “The primary care doctors don’t know how to use them and if they do, they have to fight with insurers, so they throw in the towel.” – Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center, told the New York Times on how patient who might benefit form some of the newer medicines didn’t get them because insurers required high co-pays and special approvals.
- “I have a patient who’s been waiting for over month and hasn’t been approved yet [because insurers want detailed explanations for treatment]. It’s wrong. These drugs are approved on national guidelines that have been recommended for [patient] care. There’s no debate on whether they’re useful. It’s just that, I think, the insurance companies are trying to conserve their dollars.” – Dr. Richard Elion, Director of Clinical Research, Whitman-Walker Health Clinic, told McClatchy.
Robert Zirkelbach Robert Zirkelbach is Executive Vice President of Public Affairs at PhRMA. He joined PhRMA in 2014 after working for seven years representing the health insurance industry. He likes Saturday afternoon BBQs on his deck, traveling, trying new restaurants, and attempting to play golf. He’s an avid, somewhat obsessive, Iowa Hawkeye fan and is lucky to have a wife that loves watching college football on Saturday afternoons.