2019 APR 05 (NewsRx) -- By a
In 2003, the
“However, in subsequent years, health insurance companies imposed greater barriers to reimbursement for growth hormone treatment,” said lead researcher
Grimberg and her co-author
The number of members with growth hormone prescriptions per 10,000 beneficiaries under age 18 rose steadily from 5.1 in 2001 to 14.6 in 2016, without a dramatic change around 2003, the year the FDA approved coverage for idiopathic short stature. Progressive restrictions on growth hormone coverage imposed by insurers and stricter formulary rules appear to have succeeded in lowering the total cost and insurer cost of treatment. However, those savings were not passed on to patients, who also were forced to switch drug brands as insurance companies changed their formularies.
While total growth hormone expenditures per patient decreased by 27 percent and the estimated insurance-paid amount decreased by 28 percent, average copayments, deductibles and total patient financial burden increased by 161 percent. Between 2001 and 2007, beneficiaries switching growth hormone brands at least once in the year ranged from 1.4 percent to 3.6 percent. After 2007, the range rose to 5.1 percent to 8.8 percent, with 25.6 percent switching in 2009 and 13.9 percent switching in 2015.
“These patterns are consistent with broader
Grimberg noted that the patient burden of growth hormone brand switches and insurance denials/appeals is a source of great distress for patient families seeking evaluation and treatment of short stature. “Because the different growth hormone brands are delivered in different pen devices, insurance-mandated brand switches during the years a patient is treated with growth hormone require retraining on proper administration, so the process is more complicated than simply switching from one pill to another,” she said.
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