Heart disease is the longstanding No. 1 killer of Americans, and the leading cause of death among Marylanders. While this silent killer devastates populations of all racial and ethnic groups, African-Americans are at the highest risk – deaths from heart disease among African Americans are 30 percent higher when compared to the White population.
Many African-Americans are all too familiar with family members who have struggled with this disease and have witnessed firsthand the devastating effects from physical to psychological to financial. With new breakthroughs in life-saving medicines, why does this death toll remain so high? Access continues to be a defining problem for doctors and their patients.
Even as specialty drugs have become available to treat conditions like high cholesterol, insurance companies and others are working to keep their own costs down by limiting patients’ coverage for them. An April story from the Association Press tells the story of Christian Jacobs, a 24-year-old with a rare form of inheritable high cholesterol.
He takes eight medications, including blood thinners for seven stents that keep his arteries open. When Christian found out that UnitedHealth, his insurer, wouldn’t cover a breakthrough drug, Repatha, which is designed for patients like Christian, he was shocked.
“‘I was floored,'” he said. “‘How in the world can we be rejected for a medication that I meet every single standard for?'” Instead, his insurer said he should maintain his current drug regimen.
Christian’s condition may be unique, but his story is not. Aggressive anti-patient maneuvers have become all-too-common in the health care industry in America today. Even as uninsured rates plummet, especially among minority populations, out-of-pocket costs are growing at rapid rates.
According to the Kaiser Family Foundation, the average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015.
That’s a staggering 255 percent increase. Insurance companies and pharmacy benefits managers are some of the most vocal opponents of high prescription drug prices, but patients are the ones really footing the bills. People from lower income communities, as well as retirees, are especially susceptible and are being hit hard with increased cost for quality care and drugs.
The entry of “independent” non-profits into the national debate over health care costs should be of concern to patient advocates as well. The Boston-based Institute for Clinical and Economic Review (ICER) has been called the “de facto arbiter for the nation’s medicine chest.”
ICER evaluates prescription drugs that have been recently approved by the Food and Drug Administration and makes a determination if they’re too expensive. As part of these drug reviews, it has called for discounts up to 94 percent of the list price of the drug. Insurers and PBMs, in turn, cite ICER reports while pushing for lower prices from pharmaceutical companies, or to justify extensive bureaucratic requirements like prior-authorizations that effectively restrict patients’ access to medications.
ICER’s heavy dependence on the insurance and PBM industry for financial support calls its independence into question, and should give pause to those in the health care industry who’re looking for expert opinions. With the rise in anti-patient policies already underway, the payers don’t need further justification to put the squeeze on patients from media stories that don’t reveal ICER’s bias for the payers’ bottom line.
As noted by Dr. Sean Francis, an obstetrics and gynecology specialist at the University of Louisville, “Every day, it seems, insurers and other middlemen put new restrictions on what drugs can be given to our patients, and how they can be prescribed.”
The effects of these policies on patients and vulnerable populations are already problematic. If they continue to worsen, they may turn America’s access to medicines issue into a full blown crisis.
Reverend Derek McCoy is the national director for the Center for Urban Renewal and Education (CURE) and an associate pastor at Hope Christian Church in Beltsville, MD.
