Will Insurers Come Through for Respiratory Patients?

April 23, 2021

This could be a life-changing year for chronic respiratory patients. 

In addition to the slow-but-steady progress against COVID-19, now comes news that highly anticipated treatments for asthma, COPD and other conditions could soon be up for approval before the Food and Drug Administration. As of 2019, dozens of new treatments were in the approval pipeline, and more than 30 in advanced Phase III testing. Among them is a biologic that has shown unprecedented promise for treating uncontrolled asthma. 

After the extra burden asthmatics and other respiratory patients have borne during the pandemic, this good news cannot come soon enough.

But new medications don’t always flow directly to the millions of Americans waiting for them. Access to these drugs will be in the hands of health insurance companies. That could mean that patients find themselves waiting longer than they should.

New-To-Market Exclusions

One potential delay could stem from what are known as new-to-market exclusions.

In recent years, insurers have often delayed covering newly approved medications. Patients are told to wait a few months, or until the next coverage year, before the meds are added to the insurers’ approved list. These exclusions are arbitrary and generally prioritize profits over patients’ health, quality of life and economic wellbeing.

Yet this tactic is becoming more common. “New-to-market exclusions” jumped 160% between 2014 and 2018. The trend does not bode well for patients who could otherwise benefit from medical research and innovation.

Prior Authorization Delays

Another potential barrier for respiratory patients comes in the form of prior authorization.

With prior authorization, insurance companies may cover a certain treatment but require doctors to complete onerous forms and submit clinical notes and records before prescribing them. When initial requests are denied, doctors must follow through on appeals or peer-review calls, when the patient’s doctor makes his or her case to a doctor employed by the insurance company. 

The paperwork battle can delay treatment for patients who desperately need it – and distract physicians and their staff from actual patient care.

Treatment Access for Respiratory Patients 

These barriers detract from what promises to be an otherwise transformative moment for respiratory patients, their physicians and families. 

They are overdue for some good news. With the right policies in place, access to medications that could control their condition and restores quality of life could provide just that.

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