Largest Michigan Medicare Plans Receive Failing Grades For Coverage Of Autoimmune Disease Medications

DETROIT, Nov. 29, 2018 /PRNewswire/ -- As Michigan's Medicare beneficiaries shop for coverage during open enrollment, new research shows that those living with autoimmune diseases do not have many options for plans that will grant them ample access to the medicines they need. This is according to a new report card released today by Let MI Doctors Decide, which assigned the grades for patient access to medicines according to the level of health insurance restrictions imposed. Restrictions such as step therapy and other access limitations all too often result in seriously ill patients being denied medicines that doctors have prescribed.    

The report card, based on a report from researchers at Emory University and released less than 48 hours after the Centers for Medicare and Medicaid Services (CMS) proposed a rule that would let insurers increase the use of harmful step therapy practices in the Part D program, analyzes access restrictions by the state's 25 largest Medicare health plans for five key autoimmune conditions. They include Crohn's disease, multiple sclerosis, psoriasis, psoriatic arthritis, and rheumatoid arthritis. For each of the five autoimmune conditions studied, the average grade was an F for the top 25 Medicare plans, including plans associated with national insurers like AARP, Aetna, Cigna, and Humana. It follows the release last month of a report card that evaluated the largest 25 private and public health plans in Michigan according to their access restrictions on medications for autoimmune conditions.

"Senior citizens are already some of the most vulnerable patients in our health care system, and those with autoimmune diseases face even greater challenges to maintaining their health and quality of life," said Virginia Ladd, President and Executive Director of the American Autoimmune Related Diseases Association (AARDA), which launched Let MI Doctors Decide in 2017. "The last thing these patients need is the extra burden of insurance company practices like step therapy, which restricts access to necessary medicines for the sake of perceived short-term cost savings for the companies."

Recent research has shown that patients with autoimmune conditions who are in need of specialty medicines are more likely to be forced to surmount access restrictions such as step therapy. Under this practice, coverage of prescribed treatment is delayed when insurance companies require that patients first try several drugs before covering the doctor-recommended medicines. For seniors who rely on Medicare for important prescription medications, recent proposals to lessen existing protections to access to medicines for Medicare beneficiaries are likely to compound these challenges and make access to needed medicines even more difficult – whether autoimmune or other serious medical conditions.

Let MI Doctors Decide, launched by AARDA in October 2017, provides patients and doctors with tools and resources to access the right medicine at the right time. The initiative is supported by a task force of leading state and national health care organizations, including The American Behcet’s Disease Association; Asthma & Allergy Foundation of America, Michigan Chapter; Hemophilia Foundation of Michigan; Michigan Rheumatism Society; and the Scleroderma Foundation, Michigan Chapter. The new report card is the latest tool introduced by the group to bring awareness to the practice of step therapy and provide patients and doctors with the resources they need to navigate it.  

For a full copy of the report card, visit www.letmidoctorsdecide.org.

About the Report Card

The Let MI Doctors Decide Medicare report card is based on an October 2018 report from researchers at Emory University, utilizing data provided by Managed Markets Insights and Technology, Inc. (MMIT). That report evaluated the top 25 private and Medicare health plans in Michigan based on their overall access to medicines indicated for each of five autoimmune conditions (Crohn's disease, multiple sclerosis, psoriasis, psoriatic arthritis, and rheumatoid arthritis). The researchers developed a point system based on these access restrictions including formulary status, tier placement, prior authorization requirements, and step therapy requirements. Let MI Doctors Decide then assigned letter grades to each of the plans based on the point system to come up with data for a "report card." This methodology formed the basis of the Medicare plan report card. To learn more about the methodology, visit the Emory report and executive summary for the initial Let MI Doctors Decide report card.

About Let MI Doctors Decide

Let MI Doctors Decide is an initiative of the American Autoimmune Related Diseases Association (AARDA) dedicated to helping patients who have been forced to go through step therapy by their insurance companies. Visit www.letmidoctorsdecide.org to learn more.

About AARDA

Founded in 1991, AARDA is the only national nonprofit organization focused on addressing the problem of the autoimmune disease category, the major cause of over 100 serious chronic diseases. Through collaborative efforts in the areas of education, public awareness, research, and patient services, AARDA is dedicated to the eradication of autoimmune diseases and works to alleviate both the suffering and socioeconomic impact of autoimmunity nationwide. To learn more, visit aarda.org.

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SOURCE AARDA