State-by-State Resources Available to All Chronic Disease Patients

Global Healthy Living Foundation recently published A Patient’s Guide to Insurance Enrollment to help people living with chronic disease understand and make decisions about their health insurance coverage options in time for the 2019 open enrollment season. “Patients shouldn’t need specialized education to understand insurance, but unfortunately, they do because of the complex structure of insurance policies,” said Seth Ginsberg, president and co-founder of the Global Healthy Living Foundation.

A Patient’s Guide to Insurance Enrollment defines common benefit terminology, explains how to decode a formulary and tiered drug lists to determine available prescription coverage, organizes the paperwork and information a family needs to apply for coverage, and guides people to resources in every state that are set up to facilitate enrollment in private, employer-based, and/or public health insurance options. The program launch anticipates the start of open enrollment to 2019 health insurance contracts, typically in November, to allow people ample time to access this resource. It was designed to be used by patients and their families in need of specialty care for any chronic disease.

“People managing a lifelong, chronic illness rely on stable access to their doctors and medications, but the deliberately complex language used in health insurance policies makes it hard for people to decipher available benefits and their price points,” Mr. Ginsberg said. “Insurers can change programs within the fine print, and these changes can cost patients more money out-of-pocket. Our response was to create an online resource to arm the chronic disease community with what they need to know to identify, apply, and sign-up for the optimal health plan they can afford – while avoiding some new plan design features that hit patients’ wallets hardest.”

A Patient’s Guide to Insurance Enrollment expands on the recently published A Patient’s Guide to Healthcare, a comprehensive and free, downloadable booklet that explains the different kinds of insurance coverage available while empowering patients to advocate for themselves and the chronic disease community.

Protocols and Policies Impede Patient Care

Every day, Global Healthy Living Foundation hears from people living with chronic diseases, ranging from osteoarthritis, chronic inflammatory diseases such as Rheumatoid Arthritis or Crohn’s Disease, migraine, and cardiovascular disease, regarding the challenges they face accessing the treatments they’ve selected in consultation with their health care provider. Health insurance protocols such as step therapy (“fail first”), prior authorization, and non-medical switching all delay or sometimes prevent access to prescribed medications, which can lead to serious health consequences. The newest and often unannounced protocol employed by health insurance companies to influence prescription coverage are co-pay accumulator adjustment programs, which shift the cost of prescribed medications to patients because they do not apply the value of their co-pay assistance card to patients’ deductibles.

“For years, my co-pay assistance card covered $12,000 in annual prescription assistance, which more than covered my deductible and co-pays, thereby allowing me to maintain stable access to my medications to adhere to my treatment plan,” said Kip Burgess, a Chicago-based CreakyJoints® member who also serves as a patient governor to the ArthritisPower® Research Registry. “This March, I was shocked to be billed for my medication by the specialty pharmacy, and it took more than two weeks of phone calls and emails to find out from my health insurance provider that my co-pay assistance was used up, but not applied to my deductible. Out of the blue, I owed $4,500 to cover my deductible and my co-pay jumped from $10 to $200. Certainly, I didn’t budget for this expense nor did it seem fair given how my plan worked in the past. I received no communication about the change.”

“Kip’s experience is not isolated. Many of our members have found that insurance companies are shifting drug costs to them, despite the availability of co-pay assistance,” stated Mr. Ginsberg. “Given our deep understanding and concern about health insurance protocols and their impact on the patient-provider relationship, A Patient’s Guide to Insurance Enrollment prepares the chronic disease community to translate insurance policy language and to discover provisions that might limit their access to medicine.”

A Patient’s Guide to Insurance Enrollment is available for free at http://www.50statenetwork.org/patient-guide-health-insurance/.

Read the full press release here.