US Patients Being Denied Access to Life-saving Drugs

US Patients Being Denied Access to Life-saving Drugs

Reliable services from a medical transcription company and good healthcare policies are crucial if physicians are to focus more on providing patient care.

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Physicians are overworked and overstressed; there is no doubt about that. On top of that, introduction of EHR and the various policies of healthcare plans and authorities add to their workload. While the data entry needs related to EHR can be addressed with the help of a good medical transcription company, providers continue to be harassed by requirements such as prior-authorizations demanded by health plans and authorities. A December 2016 AMA survey shows that 75% of practicing physicians reported prior authorizations as a high burden for them and their staffs. 22% of physicians said that they

and

their

staff

spent

20

hours

per

week

processing

prior-authorization

requirements.

A study presented at the recent American College of Cardiology annual meeting in Washington D.C., showed that long-winded prior authorization requirements are resulting in denial of appropriate treatment for patients. These concerns were discussed at a forum on physician autonomy in Washington that was hosted by the Galen Institute, and in which physicians, policy experts and patient advocacy group representatives participated.

Dr. Seth Baum, the keynote speaker, made some very pertinent observations. He pointed out that while it is important for patients to become aware of the obstacles that physicians face in prescribing innovative treatment for them, it is also important to restore the patient-doctor relationship and leave it to the patients and doctors to follow the rules in prescribing medication. The “fail first” policy requires doctors to prescribe cheaper medicines to their patients and only if the patients fail on those drugs, can doctors prescribe breakthrough treatment that in the physician’s expert opinion would be more effective.

After the forum, Dr Baum presented the results of a study conducted at the American College of Cardiology, in which he was the lead investigator. The study evaluated 50,000 patients who had been prescribed a medicine to treat a genetic disorder that causes their body to produce more cholesterol. Four out of five patients were denied access to the drug “PCSK 9 inhibitor” by their private health plans as well as Medicare. Results released at the cardiology conference showed the cholesterol dug outperforms statins.

Patients treated with this drug were 27% less likely to have a heart attack and 21% less likely to have a stroke over two years than if they had been taking statins alone. But Dr. Baum’s study found that most of the patients were denied access to these drugs initially.

Dr. Jeff English who specializes in treating patients with multiple sclerosis said that physicians are sometimes forced to change the patient to another drug because of payer decisions, and it can be harmful for the patients. Other participants at the Galen forum said that they were working with alternative care models that avoid third party insurers

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in providing routine care, with medical students to educate them about the challenges they face, and in working with the states to advance policy changes that would empower patients. The American Medical Association on their part has developed 21 principles to guide health plans, benefit managers and others conducting utilization management in making decisions about medical and pharmacy benefits in conjunction with various other medical associations.

Reliable support services such as those provided by a medical transcription company, and good healthcare policies are necessary for physicians if they are to focus more on providing patient care. The third-party payment system is deep-rooted in American medicine, so it is indispensable that constructive discussions are held on the concerns related to this system. The value of new drugs and the cost savings they can ensure need to be discussed clearly.

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(800) 670 2809