Insurance companies shouldn’t limit access to care

Trade group leader says consumers are being squeezed

By Sara Radcliffe

Sacramento Business Journal

As the Legislature wrestles with health care issues, it’s important to place the discussion about prescription drug costs and their clinical and economic benefits in its proper context.

Even as the Affordable Care Act is implemented, there is no denying that the rise of health care costs continues to pressure consumers across California — including state and local governments.

But patients, and especially chronically ill patients, should not be forced to bear the brunt of these pressures. Consumers deserve protection from escalating insurance premiums that block their access to needed care.

Many consumer protections are found in existing laws regulating health plans. And Covered California recently has adopted provisions that help ensure patients have access to medically necessary medications through their health insurance. Health plans should not be allowed to use so-called “utilization controls” to circumvent those protections for certain classes of patients.

In recent years, breakthrough medicines have been developed to treat conditions from HIV to Hepatitis C to cancer. And while much of the attention has focused on the up-front cost of these medicines, the fact is that these products wind up saving patients, our health care system — and health insurance companies — millions by preempting surgeries, lengthy hospital stays and other costly medical procedures. The cost savings to the health care system, along with the health and quality-of-life benefits these breakthroughs provide, need to be a part of the discussion.

The fact is that prescription drug costs are still just 2 percent of all Medicaid spending, according to a recent analysis from the federal Government Accountability Office.

And yet consumers are feeling the squeeze as health insurance companies continue to increase out-of-pocket costs through high co-pays and tiered pricing schemes. This undermines the very purpose of health insurance and health care reform, which is to spread risk so that all patients have affordable access to the medicines they need.

These also are insurance company practices that have been the subject of at least one federal civil rights and discrimination complaint. California lawmakers should prevent and eliminate such discriminatory practices here in our state.

Sara Radcliffe is president and CEO of the California Life Sciences Association, a nonprofit public policy organization that represents leading companies and research organizations in biotechnology, pharmaceutical and related industries.