The Autoimmune Advocacy Alliance (A3) public policy priorities are focused around three core issues. A3 advocates for wider access to quality and affordable health care coverage, decreasing cost shifting to the consumer, and providing greater access to medications.
Access to Quality and Affordable Health Care Coverage
A3 supports efforts that make insurance and access to care more affordable.
Paying for health care has become increasingly burdensome for families living with autoimmune disease. If you live with one or more autoimmune conditions, it is essential to have health insurance that is fair and affordable.
There are many living with chronic disease, including the uninsured and many “underinsured” individuals who are unable to receive quality care and medically necessary treatments and services due in part to the high cost of obtaining adequate health insurance coverage. Under the Affordable Care Act, affordable access to insurance for these individuals can be provided through new opportunities including health insurance exchanges, co-ops, and Medicaid expansion.
Decreasing Cost Shifting to the Consumer
A3 supports policies that will result in the reduction of cost burdens on patients.
As the cost of health care services has steadily increased, more and more health care costs have been shifted to consumers, who must cope with not only larger premiums but rising deductibles, higher co-payments and co-insurance making out of pocket costs unreasonable.
Patients living with serious, rare and often expensive autoimmune disease are disproportionately impacted by this recent trend of cost sharing.
In designing insurance benefits, cost-shifting tools such as these, should be used thoughtfully and carefully to ensure they do not adversely impact patient access to necessary treatments and medicines.
Access to Medications
A3 active supports lowering barriers for patients who need access to medications.
People living with many different types of chronic and often life threatening autoimmune disease depend on medications to help treat their conditions. Often these treatments are costly and even with good health insurance many patients have limited access to them.
The following are insurer practices that create barriers to access that have increasingly become burdensome to patients living with autoimmune conditions:
- Specialty Tiers/Co-insurance: cost sharing “tiers” (levels) used by health plans that place expensive biologics on higher tiers where the patient is required to pay a percentage of the cost of the prescribe medicine (co-insurance) rather than a flat fee (co-pay). The patient’s out of pocket costs can be as high as 50% on some plans.
- Step Therapy/Fail First: requires patients to first “fail” on a less costly medication before access to a more appropriate alternative.
- Prior Authorization: the process of obtaining pre-approval from a health plan (payer) for a prescribed therapy. This creates unnecessary administrative hurdles to obtaining care for serious diseases.