As heart disease plagues Black community, access to medicines may be headed for crisis

“’I was floored,’” he said. “’How in the world can we be rejected for a medication that I meet every single standard for?’” Instead, his insurer said he should maintain his current drug regimen.
Jacobs’ condition may be unique, but his story is not. Aggressive anti-patient maneuvers have become all-too-common in the health care industry in America today. Even as uninsured rates plummet, especially among minority populations, out-of-pocket costs are growing at rapid rates.
According to the Kaiser Family Foundation, the average deductible for people with employer-provided health coverage rose from $303 to $1,077 between 2006 and 2015.
That’s a staggering 255 percent increase. Insurance companies and pharmacy benefits managers are some of the most vocal opponents of high prescription drug prices, but patients are the ones really footing the bills. People from lower income communities, as well as retirees, are especially susceptible and are being hit hard with increased cost for quality care and drugs.
The entry of “independent” non-profits into the national debate over health care costs should be of concern to patient advocates as well. The Boston-based Institute for Clinical and Economic Review has been called the “de facto arbiter for the nation’s medicine chest.”
ICER evaluates prescription drugs that have been recently approved by the Food and Drug Administration and makes a determination if they’re too expensive. As part of these drug reviews, it has called for discounts up to 94 percent of the list price of the drug. Insurers and PBMs, in turn, cite ICER reports while pushing for lower prices from pharmaceutical companies, or to justify extensive bureaucratic requirements like prior-authorizations that effectively restrict patients’ access to medications.
ICER’s heavy dependence on the insurance and PBM industry for financial support calls its independence into question, and should give pause to those in the health care industry who’re looking for expert opinions. With the rise in anti-patient policies already underway, the payers don’t need further justification to put the squeeze on patients from media stories that don’t reveal ICER’s bias for the payers’ bottom line.
(Reverend Derek McCoy is the national director for the Center for Urban Renewal and Education and an associate pastor at Hope Christian Church in Beltsville, Md.)
 
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