Let My Doctors Decide Releases New Patient Principles, Calls on Insurers and PBMs to Adopt for Patients

Business Wire

DETROIT--(BUSINESS WIRE)-- Let My Doctors Decide, a national partnership of leaders across health care working to ensure that treatment decisions are left up to doctors and patients, today released a number of new Patient Principles. Building on its recent release of a report card that shows insurance companies and pharmacy benefit managers (PBMs) are imposing significant access restrictions on patients with autoimmune disease, LMDD is calling on insurers and PBMs to adopt the principles and eliminate disruptive step therapy protocols that exacerbate the problem.

The LMDD Patient Principles that put patients first are:

Patients and physicians should make individual treatment choices.
You cannot treat all autoimmune diseases the same, as the responses to therapies vary widely from patient to patient.
Patients should have access to easily understood information about their coverage: what is covered, how much it will cost them personally, and how to get coverage approved for the treatment they need.
At the pharmacy counter, patients should receive discounts, rebates, and other insurer and non-insurer savings that help make medicines more affordable.

“Strong clinician-patient relationships are essential to achieving positive outcomes for patients and facilitating a more workable system for all health care stakeholders,” said Randall Rutta, Executive Director, LMDD. “Our Patient Principles are based on the firm belief that treatment decisions should always be made by patients and trusted health care professionals, not insurance companies or pharmacy benefit managers.”

LMDD will take its Patient Principles on the road this week at the American College of Rheumatology’s (ACR) Annual Meeting in Atlanta, GA. At Booth #451, visitors can endorse the Principles and sign a petition to federal and state/local policymakers to raise awareness about the negative ramifications of step therapy and encourage reforms.

ACR attendees are invited to experience – first-hand -- the frustrations associated with step therapy and “fail first” protocols in an interactive escape room exhibit. The “Escape the System” maze is designed to demonstrate the “madness” of step therapy and how it second guesses providers’ expertise, interferes with the doctor-patient relationship, and negatively impacts patient health.

In a survey by the American Medical Association, 90 percent of physicians reported that prior authorization requirements imposed by health plans have had negative clinical impacts on their patients.

“Too often, coverage policies and ‘fail first’ strategies undermine the clinician-patient relationship, harm patient health, increase the paperwork burden on clinicians, and add unnecessary costs,” said Rutta.

Research from a team at Emory University earlier this year found that most private and Medicare plans are limiting coverage on medications for five of the most prevalent autoimmune diseases. The study looked at several coverage limitations including authorization, formulary status, tier placement, and step therapy. Each plan was “scored,” and 86 percent of Medicare Advantage plans received an F for coverage of autoimmune drugs, while 48 percent of private insurers received an F. Within private insurers, another 50 percent of companies rated a C, and not one received an A.

According to survey results released last week in a white paper by Xcenda, respondents said they were concerned that step therapy diminishes the provider-patient relationship and gives their clinical decision-making role to payers – employers and health care plans -- who do not have the complete picture of the individual patient.

About Let My Doctors Decide

Let My Doctors Decide is a national partnership of leaders across health care working in support of a simple goal: treatment decisions should always be made by patients and trusted health care professionals, not insurance companies or pharmacy benefit managers. LMDD is led by American Autoimmune Related Diseases Association in partnership with other associations and patient-focused groups that offer resources to patients and physicians about navigating the healthcare system when faced with a chronic autoimmune disease.

Editor’s Note: Media availabilities and guided tours of the “Escape the System” booth are available at ACR by contacting Laura Simpson at lsimpson@aarda.org; 586.879.5670.