Insurer Practice Impacting Healthcare Access
WHEREAS, The Affordable Care Act has significantly increased the number of Americans with health insurance; however, insurance companies are engaging in practices that are targeted toward decreasing their costs and increasing their profit margins. Many of these cost cutting practices can interfere with access to quality and effective health care to persons with chronic medical conditions; and
WHEREAS, many of the newly insured persons may be unfamiliar with policy details making them vulnerable to the practices that are not in their best interests transparent in the insurance policies; and
WHEREAS, one such practice is step therapy; this is a tool insurers use to limit how much they spend covering patients' medicines. Under step therapy, a patient is prescribed one or more medicines, including off-label medicines in some instances, chosen by their insurer – usually based on financial considerations – before coverage is granted for the drug prescribed by the patient's health care provider; and
WHEREAS, another insurer practice of prior authorization; before filling a prescription for some medications, the insured may have to get approval from their insurance company to confirm coverage under that plan. If prior authorization is required and approval isn't obtained before filling the prescription, a patient could be responsible for all charges associated with the medication. In addition, healthcare providers are burdened to submit prior authorization requests to get insurer approval prior to prescribing, while patients may have to wait multiple days to get access to the prescription; and
WHEREAS, insurance companies are increasing out-of-pocket costs through higher use of co-insurance for drug cost sharing, increases to co-pays and the creation of tier systems. The result is often patients' non-compliance with medication regimes. Bills are being introduced to cap out of pocket costs so families can better afford medicines that keep them healthy, because out of pocket costs should not be so large as to act as a barrier to care; and
WHEREAS, advocacy groups have reported that these cost-containment practices are being enacted by several insurance companies throughout states across the country and many of these advocacy groups are working with policymakers to pass laws that limit/regulate insurer practices that erect questionable barriers to accessing medicines; and
WHEREAS, t he determination of the most appropriate medical treatment is best accomplished by open and transparent communication between the healthcare provider and patient. Only healthcare professionals familiar with a patient's personal medical history, including drug utilization, known sensitivities and past complications should make treatment decisions; and
WHEREAS, several advocacy groups including, but not limited to, the Lupus and Allied Diseases Association, Inc. and U.S. Pain Foundation, have committed to a legislative advocacy campaign; and
WHEREAS, the National Association for the Advancement of Colored People (NAACP) recognizes the sanctity of the Doctor- Patient relationship.
THEREFORE, BE IT RESOLVED that units will engage in activities to educate their respective communities on the Patient's Bill of Rights, help patients understand their insurance benefits and policies and encourage its communities and members to take charge of their health by researching their prescriptions and having detailed discussions with their physicians; and
BE IT FURTHER RESOLVED, that units working in partnership with any insurance companies on service projects will vet their coverage policies in an effort to collaborate with companies that are truly committed to improving public health and ensuring positive health outcomes for communities of color; and
BE IT FURTHER RESOLVED that insurance companies that sign up people in the fall with one formulary of prescription drugs maintain the same formulary throughout the following year; and
BE IT FURTHER RESOLVED that insurance companies be required to fill the first three months of a prescription, as prescribed, before requiring use of less costly medications; and
BE IT FINALLY RESOLVED that the NAACP encourages units to join coalition and advocacy groups in opposition to said practices.