Seeking Innovative Solutions to Patient Cost Sharing

The following is a summary of a Q&A with Patient Access Network (PAN) Foundation President and CEO Dan Klein by The American Journal of Managed Care. A segment of the interview can be viewed here.

What are some of the healthcare access barriers for patients with chronic diseases?

The high cost sharing tiers for specialty medications are a leading barrier to access. The features within these health insurance plans, such as high deductibles, high co-pays, and coinsurance, make it difficult for patients to either initiate, or stay on, treatment.

Prior authorization is another factor that limits access to the newest or the most innovative treatments for many patients. Other patients may be affected by network limitations; they may be restricted to the providers that they can use, or to the hospitals or other healthcare facilities that they can go to for care.

How have the costs of specialty medications influenced patient access?

The use of cost sharing, such as high deductibles and co-pays, by health insurance plans and pharmacy benefit managers have been focused on specialty drugs because they tend to be higher cost. To limit their financial exposure, payers have developed cost-sharing strategies that disproportionately affect specialty medications. This problem is critical for people with chronic and life-threatening illnesses because they tend to use specialty medications more than people with more common illnesses or conditions. Generally, the outcome has been that access is difficult for many of these people.

How have new care delivery models influenced patient access?

New approaches, like accountable care organizations, have facilitated access and have tried to help patients navigate the healthcare system. Many patients are still facing challenges with the complexity of treatment, so organizations that focus on helping patients through the maze of the healthcare system have improved adherence and success with therapy. Hopefully, more organizations will continue to try to focus on quality and provide more patient support services as part of the treatment protocol they follow.

What role does the PAN Foundation play to ensure patients continue receiving quality treatment?

The biggest role that PAN plays is to eliminate the financial barriers that: 1) prevent patients from initiating treatment in a timely fashion; and 2) make it difficult for patients to stay on and complete treatment. By eliminating deductibles and co-pays, particularly for patients who are using specialty medications, PAN has encouraged patients to stay on therapy and be more successful with their therapies.

Could you provide an overview of the new PAN Challenge grant?

The PAN Challenge is an effort to stimulate a discussion on sustainable ways to balance the cost sharing and financial issues for patients who are on specialty medications. We anticipate that the PAN Challenge will identify creative solutions that strike a balance between addressing the economic issues and the access and adherence issues. We are hoping that the PAN Challenge will get some of the best and the brightest thinkers from academia and from healthcare systems to put forward their thoughts in terms of how to address the challenges around cost sharing and being able to sustain the kinds of new and innovative treatments that specialty medications represent.

What is the importance of the challenge on healthcare policy overall and do you hope or expect the winners to influence policy?

The PAN Challenge addresses a key issue, which is how much should we ask patients to share in the cost of their care, especially patients who have chronic or life-threatening conditions. These patients are often the least able to pay for the cost of their treatment because, many times, they are unable to work and may be dealing with all of the issues around the illness, such as those that affect work and family.

We’re optimistic that the PAN Challenge will lead to good ideas coming forward, and we’re very hopeful that the healthcare policymakers will hear some of these ideas and perhaps adopt them as they look at ways to address the question of how to balance economic issues with access, affordability, and adherence issues. Whether or not the PAN Challenge gets translated directly into public policy is hard to say at this point.