Patients with Respiratory Conditions Struggle to Access Needed Medications

August 13, 2015

by Amanda Conschafter, blog editor

For many Americans with respiratory conditions, the struggle to breathe is now exacerbated by the struggle to pay out-of-pocket expenses for the medications that alleviate their symptoms. Chronic obstructive pulmonary disease (COPD) affects an estimated 24 million Americans, while asthma affects 26 million Americans – 7.1 million of them children. Meanwhile, pulmonary fibrosis has increased by 150 percent since 2013, and respiratory syncytial virus causes 4,500 deaths per year in children five years of age and younger. Promising medical therapies can improve quality of life for these patients—but only if they can access them.

Asthma

Respiratory conditions often compound existing disparities, impeding access to needed medications. Asthma disproportionately affects minorities as well as inner-city and low-income children. And statistics underscore these families’ financial challenges in accessing asthma medications. Though minority children, African Americans and Puerto Ricans in particular, are more likely to have asthma, they are less likely than white children to take daily medication to control the condition. A 2012 studyreported in the Journal of the American Medical Association found that increased cost-sharing for asthma medications resulted in increased non-adherence among children – and increased hospitalization.

Minority adults with asthma face similar challenges. Nearly one in four African American adults can’t afford their asthma medication. And the rates of asthma-related hospitalization and death are three times higher for African Americans than for white patients.

Respiratory Syncytial Virus

Similarly, respiratory syncytial virus can prove especially deadly for preterm infants, to which African American mothers are disproportionately prone to give birth. Nevertheless, restrictive policies issued by the American Academy of Pediatrics Committee on Infectious Diseases and adopted by state Medicaid systems often deny coverage for preventative treatment to preterm babies born after 29 weeks, despite their vulnerability to the disease.

Chronic Obstructive Pulmonary Disease 

Meanwhile, COPD patients may struggle to get necessary medication due to health plans’ cost-cutting measures such as step therapy or medication switching for non-medical purposes. As the COPD Foundation notes, “Many members of our community…have been forced to switch medications despite being well controlled on their current medication regimen and without input from their doctor. Many have experienced negative side effects and diminished quality of life due to these changes.”

Respiratory Fibrosis

The first medical therapies for respiratory fibrosis, approved by the Food and Drug Administration in 2014, have stirred fresh hope for patients suffering the fatal disease. The therapies do not eliminate the disease, though they do slow its progression—a significant advance for patients whose median survival rate is only two to three years. However, the higher prices associated with these breakthrough drugs may lead insurers to impose a heavy cost-sharing burden on patients, thereby undermining access.

To ensure that health care providers have a voice on these issues, the Alliance for Patient Access introduced this month a Respiratory Therapy Access Physicians Working Group, which promotes public policy informed by physicians’ insight. Visit AfPA’s website to learn more about the working group or to register for the annual working group meeting in Washington, DC, on November 20-21, 2015.

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