Thoughts from CBI’s Patient Assistance Conference

Thoughts from CBI’s Patient Assistance Conference

At last week’s 15th Annual Patient Assistance and Access Programs conference, I joined more than 400 industry experts to discuss the changing landscape of patient assistance. This is a hot topic that we’ve discussed here on the blog. It will continue to receive attention as the regulations are finalized. In addition to moderating a panel discussion, I was honored to answer some questions for inclusion in the conference’s Thought Leadership brochure.

What are your initial observations around patient access now that the Affordable Care Act (ACA) has been implemented?
After reviewing demographics released by the Department of Health and Human Services (HHS) for the 2.2 million people who enrolled in exchange plans through December, it was startling to see that only 24% of enrollees were between the ages of 18 and 34. Patient advocates are concerned that, given the poorer risk profile for exchange plan members, insurers could look to increase premiums for these plans in 2015 and beyond. If this trend continues, it could have material implications for patients seeking affordable coverage options through the exchanges.

Of all the areas of ambiguity and uncertainty, what, in your estimation, has posed the greatest challenge to PAPs and, ultimately, patients?
The ambiguity around whether qualified health plans in the exchanges will be treated as private or public insurance has created a difficult dilemma for pharmaceutical manufacturers who want to provide cost sharing support for underinsured patients enrolled in these plans. In late October 2013, the head of HHS drafted a letter stating the exchange plans would be treated like commercial insurance. A couple of weeks later, CMS contradicted this guidance by stating any direct cost-sharing support for these members could potentially be viewed as a violation of the federal anti-kickback statute. Considering cost-sharing obligations in most Bronze plans is around 40%, this lingering ambiguity is likely to create serious access challenges for patients.

What is your strategy for meeting these challenges?
At UBC, we understand the complex challenges and crucial decisions patients face in this post-ACA healthcare marketplace. To ensure we compliantly assist our clients’ patients in navigating this new environment, UBC was one of the first pharma service organizations to receive a Certified Application Counselor (CAC) certification. The CAC certification allows our associates to help patients who are applying for healthcare coverage within the new ACA marketplace.

On a different note, how long have you worked in the life sciences space, and what is your biggest observation?
I have worked in the life sciences marketplace for more than 15 years and it has been fascinating to watch how the commercial paradigm has shifted from prescriber- to patient-focused. By putting patients first, we all win!

Feel free to contact me when you’re ready to discuss how to put patients at the center of an ACA-complaint assistance program.