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. 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 believes that:
- Public and private health insurance options should 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.) should be 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 should include continuity of care, which should include 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 at any time the patient is a member of the health plan, 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, appropriately developed and utilized, should be encouraged and supported in public policy.
- Benefit design, in both public and private insurance options, should be robust and appropriate in serving the needs of patients afflicted with chronic disease.
- State Medicaid and Health Marketplace insurance programs should be designed and implemented with the best interests of the patient and the overall stability of the program in mind, in order to provide access to quality and affordable healthcare for all of our citizens.
- All benefit plan designs should include coverage for primary and preventive care services, including prescription drugs, combined with all levels that promote prevention for management of chronic conditions.