Quit Playing Games with Our Hearts! Payers Should Allow Access to New Heart Medicines.
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National Association of Insurance Commissioners: Tell Insurance Companies to Quit Playing Games With Our Hearts! Allow Americans Access to Groundbreaking Therapies That Prevent Heart Attacks and Strokes.
All of us know someone who has suffered from a heart attack or stroke. It’s terrifying for everyone involved.
The statistics are daunting and only seem to be getting worse: An estimated 102 million adults have high cholesterol, with more than 35 million of these at high risk for heart disease. About 5.1 million suffer from heart failure, and roughly one in three Americans has high blood pressure.
But there is hope.
In recent years, innovative medical therapies have emerged – medications that reach more patients, better control symptoms or reduce side effects that complicate treatment. Some can produce powerful results for patients who may not respond to traditional therapies.
PCSK9 inhibitors work by extending the lifespan of a receptor on the liver that clears LDL, or “bad” cholesterol. Patients are at increased risk for cardiac events such as heart attack and stroke because of extremely high levels of LDL. Clinical trials data show that PCSK9 inhibitors can lower LDL cholesterol more than older therapies like statins and can also reduce the associated risks of heart attack and stroke.
But health plan coverage has been slow to accommodate these breakthrough treatments. In some cases, plans are outright denying patients access, despite physicians’ wishes…because keeping patients off these therapies seems better for the insurance company’s bottom line.
Numbers don’t lie. Here are a few examples:
- In Alabama, Mississippi and South Carolina, Blue Cross Blue Shield denies patients PCSK9 inhibitors at rates of 61%, 100% and 83% respectively.
- In Georgia, Express Scripts and Anthem both deny 73% of patients who seek a PCSK9 inhibitor.
- In Kentucky, Anthem denies 72% of patients.
- In Michigan, Cigna denies 64% of claims.
Please sign our petition to call upon the National Association of Insurance Commissioners to fulfill its mission to assist state insurance regulators in serving the public interest. That means raising awareness about the alarming rejection rates that qualifying patients face across the country.
These rates won’t change unless we step up. That person you know who has high cholesterol may need this therapy one day. Let’s let insurance companies know that we still value patient-centered care in America.
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