How Coverage Barriers & Bureaucracy Hurt Urology Patients

March 29, 2022

Tens of millions of Americans suffer from urological disorders. New treatments offer patients options for personalized care, but policy barriers and outdated bureaucracy stand in the way.

A new white paper from the Alliance for Patient Access’ Urology Initiative spotlights these barriers and explores how reforms could improve urological care.

Insurance Coverage Policies Fail Patients and Providers

Insurers’ practices, the paper explains, often prioritize corporate profits over patients’ needs. By denying treatments that best fit patients’ needs, these policies can prove outright harmful.

  • Imposing step therapy delays patients’ access to newer, more suitable medications for their conditions.
  • Prior authorization ties providers up in lengthy back-and-forth over approvals for patients’ medications. This gambles with patients’ progress while also jeopardizing the patient-provider relationship.
  • Limiting co-pay cards’ use or not applying them to patients’ annual deductibles reduces the affordability of medications, especially for the elderly, who comprise most urology patients and may be on fixed incomes.

Reform Might Offer Relief

The paper also highlights avenues for reform.

  • Health plans can ensure payment parity for telehealth, which helps urology patients stay connected with their providers.
  • Policy reform at the health plan and state level can curb utilization management tactics like prior authorization and step therapy. Commonsense limits will allow providers to treat their patients more quickly and effectively.
  • The Centers for Medicare and Medicaid Services can revise its eligibility rules, while the U.S. Pharmacopeia can streamline its classification processes, to maximize patient autonomy and physician flexibility.

As the U.S. population ages, the number of people living with urological conditions will also increase. The need to address insurer practices that delay treatment progress, distract providers and undermine the patient-provider relationship, the paper explains, is significant.

Learn how urology care in the United States can be made more patient-centered by reading “The Need for Patient-centered Care in American Urology.”

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