Coverage -- Access: Pharma Must Play Activist Role in Health Reform Efforts

In the midst of this deep and prolonged recession, the Obama Administration has professed its commitment to overhaul the nation’s healthcare system and reduce barriers to care. As millions of Americans face the frightening reality of spiraling out-of-pocket costs, it is crucial to remember that simply having healthcare coverage does not guarantee access to treatment.

Immediate and transformational changes are essential to ensure that individuals can afford care. Under the current system, too many people who have insurance are still unable to afford the treatment they need because out-of-pocket expenses are too high. In addition to the estimated 47 million uninsured Americans, more than 25 million are underinsured, unable to meet their share of the cost burden. Consumers’ share of healthcare expenses has increased 40 percent over the past 10 years, and more than one in five patients have been forced to abandon treatment simply because they cannot afford it.

As the new Administration and Congress work toward meaningful reform, healthcare stakeholders, including pharmaceutical companies, are afforded the opportunity to collaborate on ways to strengthen the overall system. To avoid replicating the existing problems with coverage, it is imperative to consider what insurance can’t do: address the needs of individuals who cannot afford their insurance copayments, premiums, coinsurance, or other out-of-pocket healthcare costs.

President Obama understands that lack of access to preventive care and early treatment is a major contributor to the costs at the core of the crisis we now confront, as evidenced by his efforts to put together a comprehensive healthcare reform package, and a coalition of major stakeholders including PhRMA recently announced their own commitment to reduce costs voluntarily by an extraordinary $2 trillion over ten years. Public and private sector stakeholders must begin to focus on the shared commitment to reduce costs by looking beyond innovations in the lab and seeking out innovations in delivery to improve the nation’s health.

Many Americans confronting an inability to pay for health related costs are cutting pills in half to make a prescription last longer, substituting over-the-counter remedies, or simply skipping prescriptions altogether — actions that can lead to additional health problems.

Recognizing this, pharmaceutical manufacturers years ago put in place their own patient assistance programs (PAPs) and have been instrumental in helping millions of people afford life-saving medicines. These PAPs historically have been aimed at the neediest of patients, but increasingly, drug companies are stepping up to the plate and adapting to current economic conditions by dramatically expanding their programs and reducing restrictions on enrollee’s incomes. Copayment charities, such as the national nonprofit HealthWell Foundation, also assist individuals with their out-of-pocket costs for treatment, typically helping those who do not meet in-house PAP eligibility requirements. During the most recent six-month period, assistance programs have seen a 10-15% jump in inquiries for assistance. As more Americans lose their jobs — and their employer-sponsored health coverage along with them – the number of people seeking assistance will only continue to grow. And even if the recession were to end tomorrow, the current circumstances are unacceptable and untenable.

The Obama Administration took a significant step toward healthcare reform by bringing together a large and diverse group of concerned parties for a high-profile summit at the White House in March, signaling the president’s seriousness and setting the national stage with a tremendous sense of momentum. Now, a strong collaborative relationship between the public and private sectors — based on a sustained commitment to achieving meaningful reform – is the only way to ensure access to needed medicines and other care for all Americans.

Reform is on its way. The overall recession has only accelerated the already growing number of Americans struggling to afford healthcare for themselves and their families, creating unprecedented public and political will for change. With a popular president leading the charge, there is a newly felt urgency for reforming the nation’s broken healthcare system, and the pharmaceutical industry must play a key role in the process.

President Obama has invited all stakeholders to the table and solicited input from all quarters. The pharmaceutical industry has a long history of ardent advocacy for people who cannot afford the care they need, and now must seize this critical moment as activists, or jeopardize the greatest opportunity to achieve the outcome the industry has sought for decades: access to care for all who need it.

ABOUT THE AUTHOR

> David L. Knowlton is a member of the Board of Directors of the national nonprofit HealthWell Foundation (www.healthwellfoundation.org), which assists underinsured patients with serious and chronic conditions with their out-of-pocket costs for treatment. He is president of the New Jersey Health Care Quality Institute and a former deputy commissioner of the New Jersey Department of Health.