AADA offers patient advocacy assistance with drug costs

Arianne Shadi Kourosh, M.D.Dermatologists can help ensure patients' access to increasingly costly specialty drugs by getting involved at the state, national and state-society levels, said experts Friday at the 74^th Annual Meeting of the American Academy of Dermatology (AAD) in Washington D.C.

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As insured patients' copayments on dermatology drugs have soared, says Arianne Shadi Kourosh, M.D., many patients can no longer afford life-altering treatments. This problem initially impacted biologic drugs primarily, she adds, but during the past year, insurers have increased copayments on many generic drugs commonly used in dermatology - most notably, antibiotics (such as doxycycline) and some topical steroids. She is director of community health in the department of dermatology at Massachusetts General Hospital, and a faculty physician at Harvard Medical School.

As clinicians, "Our toolbox of medicines is suddenly narrowing immensely, and we aren't able to get our patients the medications we've been able to get them for years," Dr. Kourosh says.

NEXT: Calling for reform

Calling for reform

In response, the AAD Association (AADA) is among several healthcare organizations supporting the Patients' Access to Care Act (PACA, H.R.1600), introduced in March 2015 by cosponsors David McKinley (R-WV) and Lois Capps (D-CA).

Dr. Kourosh clarifies the reason for the bill: "This bill addresses the fact that insurance providers have begun putting medicines into tiers based on the medicine's cost," not its efficacy for a given patient with a particular condition. "Insurance providers are interfering in the doctor-patient relationship and creating a step-wise algorithm that they think doctors should have to follow" before the insurers will cover specialty-tier drugs.

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"Often, my patients who change insurance plans say, 'I've already tried several drugs, and the (new) insurance company is telling me I need to try them again before they'll let me have the medicine that worked for me.' I want to give the patient the drug that they know works for them, and the insurance company is demanding that we go through this obstacle course of drugs that they find acceptable. In the meantime, patients are suffering," she explains

Additionally, Dr. Kourosh says, insurers have proposed slashing the amount of coverage offered for higher-tier medications, such as life-altering biologic drugs, by 25% to 50%. With many biologics costing several thousand dollars per course, she says, these cuts would put the drugs out of reach for many who can get relief no other way.

"The PACA limits the insurance companies' ability to decline coverage for medicines in the way that they've been doing, and calls from more accountability in coverage," Dr. Kourosh adds. Specifically, the PACA would amend the Public Health Service Act by stating that insurers using formularies or other tiered cost-sharing structures shall not impose cost-sharing requirements in a specialty-drug tier that exceed the amount of cost-sharing applicable to a non-preferred branded drug tier.

NEXT: Advocacy resources

Advocacy resources

To become better patient advocates, Dr. Kourosh says, dermatologists can use resources including the AAD's Drug Pricing and Transparency Task Force (on which she and session co-director Elise A. Olsen, M.D., serve).

"Dermatologists can send questions and tell us the experiences they've been having - we’re gathering data to identify which drugs are being the most affected," she notes. The task force also has formulated a position statement that its members hope will guide upcoming legislation.

"Another great resource is the AADA's Washington, D.C., office." Here, she says, AADA and legislative experts collaborate with the AAD Drug Pricing and Transparency Task Force to provide current information that helps dermatologists understand the problem - and how they can address it in Washington. Dr. Kourosh says, "I encourage members to get involved with the legislative process. That's one of the best ways to stay informed."

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Dr. Kourosh also encourages involvement with state medical societies. Many medical issues, such as the tanning-bed legislation the AADA has successfully sponsored in many states, are legislated at the state level, she notes.

Capitalizing on the AAD annual meeting's Washington, D.C., location, Drs. Kourosh and Olsen invited representatives from Congress (including Rep. McKinley) and the Food and Drug Administration to give AAD members a chance to voice their concerns and obtain guidance from lawmakers.

Dr. Kourosh says, "It's about bringing doctors and our government officials together to consult about these issues and come up with solutions that people can use in the short term, for daily patient care, and long-term solutions we can work on together from our different spheres to impact change on a macroscopic level."

Disclosures: Dr. Kourosh reports no relevant financial interests.