Appropriate access to care is essential for all patients. Yet real access to needed mediations and treatments is increasingly difficult in this era of managed health care. In addition, continuity of care for the patient is a key factor in keeping our population healthier and in keeping the cost of health care reasonable and appropriate. The Chronic Care Policy Alliance works to ensure that:
- Public and private health insurance options include and provide affordable access to the services, medications, therapies, technology, and education necessary to meet the needs of patients afflicted with chronic disease.
- The practice of utilization review, by health insurance companies (including prior authorization, step therapy or “fail first”, non-medical switching, the development of clinical pathways, etc.) are developed and utilized based on evidence-based data and reasonable protocols that are transparent and intended for the best of quality health care for the patient. Utilization Review techniques and mechanisms should never be employed as barriers to care.
- Appropriate access to care includes continuity of care, and the benefits a patient signed up to receive when joining his or her health plan. Health insurance companies should not be allowed to alter benefit plans or switch coverage of any medication or therapy to a less expensive option, as long as the medication or therapy was covered at the time the patient signed up for the coverage, without the informed consent of the patient, and the prescribing health care practitioner.
- The use of new and innovative medications, that are approved by the U.S. Food and Drug Administration, and appropriately developed and utilized, should be encouraged, and supported in public policy.
- Benefit design, in both public and private insurance options, must be robust and appropriate in serving the needs of patients afflicted with chronic disease.
- State Medicaid and Health Marketplace insurance programs are designed and implemented with the best interests of the patient, patient centered, in order to provide access to quality and affordable healthcare for all of our citizens.
- Benefit plan designs include coverage for primary and preventive care services, including prescription drugs.