Chipping away at patient access hurdles
From the President
Dr. Olbricht served as Academy president from March 2018 to March 2019.
By Suzanne Olbricht, MD, February 1, 2019
Picture this: A sick patient comes in for your help. As an experienced dermatologist, you know exactly what to do and are confident your prescribed course of treatment will do the trick. The patient leaves with a renewed sense of optimism, and you go about your day knowing that you helped. But then you get a call from the patient. Their prescription is either not covered by their insurance, too expensive, or requires multiple layers of approval.
None of us have trouble picturing this scenario, and in fact, it’s probably happened to each of us in recent history. It can be so utterly frustrating when you — the physician — know what’s best for the patient, yet the other players in health care aren’t willing to do their part. Fortunately, our specialty isn’t just sitting back and watching these access problems unfold.
We know all too well that restrictive insurance policies, such as prior authorizations and step therapy, are daily burdens for physicians, staff, and patients. However, the Academy has developed a number of resources to help, such as the prior authorization denial letter generator and other tools that help patients navigate prior authorizations (staging.aad.org/practicecenter/managing-a-practice/prior-authorization-assistance/patient-letter-template), drug pricing, and step therapy issues.
Additionally, the advocacy arm of your Academy is actively pushing states to enact step therapy protocols (staging.aad.org/advocacy/state-policy/step-therapy-legislation). Recently, 19 states have enacted step therapy laws. At the federal level, the AADA successfully advocated for legislation requiring CMS to create a standardized electronic process for Medicare prior authorizations for medically necessary drugs in Medicare Advantage and Medicare Part D participating plans. The AADA also successfully advocated for two laws the Know the Lowest Price Act and the Patients Right to Know Drug Prices Act that lift insurers’ gag clauses’ that restrict pharmacists from informing insured patients when a drug is cheaper if paid out-of-pocket, covering private insurance and Medicare Part D respectively.
Onerous insurance policies aren’t the only issue plaguing our patients, as we continue to be adversely impacted by drug shortages — particularly lidocaine with and without epinephrine, sodium bicarbonate, and bacteriostatic saline. The AADA is engaged with stakeholders, including manufacturers, suppliers, the FDA, and Congress to facilitate access for patient care.
To top it off, physicians could be facing onerous requirements for compounding sterile preparations if the United States Pharmacopeial Convention (USP) finalizes, and state pharmacy boards adopt, changes to USP’s chapter 797 compounding regulations. Recently, the AADA — along with the American College of Mohs Surgery, the American Medical Association, the American Society for Dermatologic Surgery Association, and the American Society for Mohs Surgery — met with USP, the FDA, and the CDC at an in-person meeting to discuss the need for patient access to in-office preparations in dermatology. Additionally, the AADA called on its members to write USP and oppose these new regulations, resulting in almost 900 letters. We are hopeful that our advocacy efforts will shine a light on the significant impact these regulations will have on dermatologists and patients.
To all of our rank and file Academy members: I thank you for taking the time and going to bat for your patients by heeding our calls to action. We need to keep up the pressure. We can only go so far in helping our patients get better if they can’t get access to the medications they need. As physicians devoted to providing quality patient care, we must continue to do our part to advocate on their behalf.
