Press Release: Majority of Top Michigan Health Plans Receive a Grade of “C” or Below for Failing to Cover Autoimmune Disease Medications
Report Card Reveals Significant Obstacles to Treatment for Patients
DETROIT (October 22, 2018) - Nearly a quarter of Michigan’s largest 25 health plans received a failing grade for placing restrictions on access to medicines for patients with five key autoimmune diseases, according to a new report card released today by Let MI Doctors Decide. The new resource, based on a report from researchers at Emory University, assigned 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 analyzes access restrictions by the 25 largest Michigan health plans for five key autoimmune conditions — Crohn’s disease, multiple sclerosis, psoriasis, psoriatic arthritis, and rheumatoid arthritis. Of the 25 plans, not a single one received a grade higher than a “C” for the level of access to medicines provided across the five conditions, and five of the plans received a grade of “F.”
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. This can compromise patient health and increases administrative burdens for physicians. A new video also released by Let MI Doctors Decidethis week illustrates how step therapy works and the impacts it has on patients and their doctors.
“This report card reveals just how difficult it can be for those suffering from autoimmune diseases to get the treatment they need,” said Virginia Ladd, President and Executive Director of the American Autoimmune Related Diseases Association (AARDA), which launched Let MI Doctors Decidein 2017. “The burdens step therapy places on patients, doctors and our health care system as a whole far outweigh any perceived short-term cost savings — it is time for insurance companies to put treatment decisions for these serious diseases back in the hands of doctors where they belong.”
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.
“This report card reveals the extent to which people with autoimmune diseases face coverage restrictions on autoimmune medications across a variety of health plans.” said Ken Thorpe, Robert W. Woodruff Professor of Health Policy at Emory University and an author of the research on which the report card is based. “This resource can help Michigan consumers understand how different policies affect access and make informed choices on coverage.”
For a full copy of the report card, visit www.letmidoctorsdecide.org.
About the Report Card
The Let MI Doctors Decide 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 Decidethen assigned letter grades to each of the plans based on the point system to come up with the “report card” data. To learn more about this methodology, visit the Emory report and Let MI Doctors Decideexecutive summary.
About Let MI Doctors Decide
Let MI Doctors Decideis 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.
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.