3 Snags of Expensive Affordable Care Act Deductibles, Copays
“Will physicians make decisions to use a drug that is less costly not because it’s of value to the patient but because it’s less costly to the healthcare system?"
By - Money woes stemming from expensive Affordable Care Act (ACA) exchange policies may be hindering communication efforts between physicians and patients.
Costly deductibles and copays mean patients may be more commonly skipping chats about drug costs with their physicians, according to a recent report from OncLive.
Panelists at the 4th Annual Patient-Centered Oncology Care conference held last November in Baltimore, Maryland confirmed those patients unable to pay for out-of-pocket costs associated with a new oncologic drug may never have the opportunity to talk matters of money with their physicians.
Financial hitches are only magnified, stated panelists, when patients lack an educational background and are therefore unable to discern among available treatment options.
Several panelists at one particular session – Reimbursement Challenges for Oncology Innovation: Who Pays? – noted 3 specific problems that require immediate addressing:
Sorry, no substitutions allowed
“In many cases in oncology, there really aren’t substitutes available, so whether they can understand treatment options is not a fair question to ask," said Dan Klein, MHS, CEO of the Patient Access Network Foundation.
"Our focus is making sure that people don’t have a barrier that’s going to prevent them from using what is the recommended treatment."
“There’s a part of the community that is going to be unable to access products even when they’re priced reasonably – many aren’t – and the question becomes what kind of a safety net do we want?”
More focus is still needed on paying for outcomes
“We pay a lot of dollars in the healthcare system for drugs that don’t work as predicted in clinical trials, and in [the] future we’re interested in long-term arrangements with manufacturers based around paying for outcomes rather than whatever price they demand,” asserted John Fox, MD, MHA, Senior Medical Director at Priority Health of Michigan.
“Will physicians make decisions to use a drug that is less costly not because it’s of value to the patient but because it’s less costly to the healthcare system? … [Physicians] certainly have a lot of influence over what drugs they’re going to choose based on cost and efficacy.”
More assessment of whether or not cost savings are worth it is needed
“I’m starting to have a conversation with patients about how much a particular treatment may cost them, and whether it’s worth a potential month’s improvement in survival for thousands more dollars,” added Yousuf Zafar, MD, MHS, Professor of Medicine at Duke Cancer Institute.
The healthcare system needs “more quality, more pathways, more guidelines, [and] more ways of reconciling what’s happening in that box to ensure that at least it’s up to standards," advised Peter Bach, MD, the Memorial Sloan Kettering Cancer Center’s Director of the Center for Health Policy and Outcomes.
Looking ahead: many still remain without coverage, others simply cannot afford to use it
The panelists’ points are perhaps even more relevant as issues of increased uninsured rates gain prominence.
According to one estimate from the Congressional Budget Office, nearly 27 million people may become uninsured over the next decade.
Other numbers look a bit better. The number of uninsured individuals reportedly declined from 42 million in 2013 to 33 million in 2014 – perhaps because of ACA implementation.
But some important points within such data are perhaps being glossed over.
“[The] Census Bureau report leaves entirely unmentioned the millions of people who have health insurance but who can’t afford to use it because of high deductibles and copays,” confirmed Robert Zarr, MD within a press release.
Because of an alleged 33 million who went uninsured last year, “33,000 people died needlessly last year because they couldn’t get access to timely and appropriate care. … “[The] number of people who remain without coverage is still intolerably high.”
“A single-payer system would achieve truly universal care, affordability, and effective cost control. It would put the interests of our patients — and our nation’s health — first.”
“We need to move beyond the administratively wasteful, complex and inadequate ACA to a more fundamental, comprehensive single-payer national health program for all.”
