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Column: Protect patients' access to effective drugs

 
Prescription bottle with money.
Prescription bottle with money.
Published Jan. 8, 2016

Imagine for a moment that you're living with a serious chronic illness or a rare medical condition.

Finding an optimal treatment has been a challenge for you and your doctor. You've tried a few medications, and you both have finally found a treatment that works especially well for you — the drug is well tolerated, you're getting relief from your condition, and your doctor is pleased with the clinical results. Plus, the drug is covered by your health insurance plan, and you can afford the co-payments.

Now imagine that — for no medical reason — your insurance plan suddenly removes a drug from its list of covered medications, or even moves that drug to a higher tier, increasing your co-pay and making it unaffordable for you.

Perhaps you don't have to imagine this scenario, because you are one of the many Floridians for whom this is a reality. Your health insurer or health plan's pharmacy benefit manager has effectively forced you to switch from the treatment that was keeping you healthy.

And if you're living with a complex, infectious, chronic or rare condition, this treatment switch could put your health at risk, potentially causing adverse side effects and even decreasing the effectiveness of your original medication. In fact, one recent study of Crohn's disease patients found that switching from one therapy to another was associated with loss of effectiveness of the medication within one year.

While health plans initiate these treatment switches to cut cost, the reality is that they can actually increase systemwide costs, especially when patients with complex diseases are switched. Not only can these unnecessary treatment switches lead to serious health consequences and reduced quality of life, they also translate to expensive emergency room visits, hospitalizations, additional physician visits and lab tests.

Fortunately, the Florida Legislature has the chance to protect vulnerable Floridians living with complex, infectious, chronic or rare medical conditions.

Legislation known as the Patient Stability Act (HB 915 / SB 1142), now pending before the Legislature, would keep commercial health plans and pharmacy benefit managers from pulling the rug out from Floridians who need their life-saving medications the most. The legislation would allow patients who are suffering from complex, infectious, chronic and rare medical conditions and are stable on their current medication the ability to remain on that medication as long as they maintain coverage through the same health plan.

Additionally, it would prevent health plans and pharmacy benefit managers in the state from increasing these patients' out-of-pocket costs mid-plan year or moving the medication to a more restrictive and inaccessible drug tier during the health plan year.

Insured Floridians, especially those living with debilitating health conditions like HIV/AIDS, hepatitis, cancer, epilepsy or lupus shouldn't have to live in fear that the insurance coverage they signed up for won't be the coverage they receive. State legislators should enact the Patient Stability Act.

Michael Ruppal is executive director of the AIDS Institute, a national nonprofit dedicated to supporting and protecting health care access for people living with HIV/AIDS and other chronic diseases. The author, who lives in Tampa, wrote this exclusively for the Tampa Bay Times.