The Discussion About Access We Need To Have

posted by Karen Ignagni

on May 10, 2015

Health care is changing. Consumers are driving the new, evolving market by expressing their desire for affordability and choice. As health plans build benefit packages and coverage options for individuals, families, and employers, they are pioneering ways to unlock the system for those seeking coverage for the first time. Health plans also are providing support to physicians and nurses to improve patient care and are working to bring the best value to consumers and employer purchasers.

But to provide the affordable coverage that consumers want, all stakeholders have to be willing to embrace the goal of affordability and work together to achieve it. This means that the old ways have to change.

A case in point is a recent report on coverage of contraceptive benefits. Contrary to the report’s findings, health plans provide access to a wide range of contraceptive options as required under federal law. Our clinical teams develop coverage policies to ensure women receive care that is safe and effective, which is important since every contraceptive method has benefits and risks. Health plans also negotiate prices with pharmaceutical manufacturers to bring the most affordable treatment options to consumers.

That last point is key to understanding the shortfalls with recent policy discussions around coverage. As drug prices continue to escalate, drug manufacturers are looking for every opportunity to quash the debate on the impact of costs to consumers and the health system more broadly. The dream play for drug manufacturers would be a requirement to cover every possible contraceptive therapy for free. Then no one would have any incentive to question the prices being charged for these medications. Moreover, efforts to inform patients about treatment alternatives that are more clinically safe and effective would be eliminated, and there would be no price negotiation. Mission accomplished for drug manufacturers.

This is why narrowly focusing on insurance coverage – without taking into account what health plans, providers, and clinicians are doing to address the real cost and quality challenges facing the health system – jeopardizes ongoing efforts to improve patient access to these important treatments. We need to broaden that debate and have the discussion about why the prices for these products remain high and, in some cases, continue to go up. Patient access is dependent on achieving affordable, sustainable pricing, and no one has the right to a blank check. For our part, health plans are focusing on ensuring that women understand how their coverage works, including the process to waive cost-sharing if a particular form of contraception is more clinically appropriate.

All of us want a health care system that enables us to have the right care at the right time. But that will be an elusive goal unless all players focus on improving affordability for individuals, families, employers, and public sector programs. Without a discussion of access and cost together, health care services will be neither affordable nor accessible. All stakeholders need to confront that reality.

Karen Ignagni is former the President and CEO of AHIP.

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