AGA joined the launch of “Let My Doctor Decide,” a national partnership of leaders across health care working to ensure that treatment decisions should be made by patients and their physicians, not by insurance companies or pharmacy benefit managers. Unfortunately, with utilization management tools being implemented more often by insurance companies, patients with inflammatory bowel disease are not receiving the treatment that they need to manage their diseases in a timely manner.
Let My Doctor Decide released a report card as part of the launch to highlight how insurers rate in providing access to medicines for patients with autoimmune diseases like Crohn’s disease. The analysis is based on research from Dr. Kenneth E. Thorpe and Manasvini Singh of Emory University and highlights the extent to which private and Medicare Advantage plans utilize coverage limitations on medications for five of the most serious autoimmune diseases: Crohn’s disease, multiple sclerosis, psoriasis, psoriatic arthritis and rheumatoid arthritis. The coverage limitations evaluated include prior authorization, formulary status, tier placement and step therapy.
In addition to educating physicians and patients on step therapy, Let My Doctor Decide will work to propose solutions to prevent step therapy and other harmful practices from being used by payors and will provide tools and resources to help patients overcome these access challenges.
AGA has been advocating in support of HR 2279, the Safe Step Act, legislation introduced by Reps. Raul Ruiz, D-CA, and Brad Wenstrup, R-IN, that would provide patients with a clear, equitable and transparent appeals process when subject to step therapy protocols. AGA believes that this legislation is a common sense approach that will protect patients who would be potentially harmed by being forced to try and fail a therapy that is not in their best interest.
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.