When a health insurer can cost you your life

6.14.17

We all know that having your health insurer refuse to cover a needed medication or treatment can be an annoyance. But for many patients, this rejection is deadly.

The Institute for Patient Access recently issued report cards showing how health insurance plans are doing when it comes to patient access to crucial cardiovascular treatments. The results aren’t very good.

National data shows that patients are struggling to access PCSK9 inhibitors, which are designed for patients with high levels of bad cholesterol. The Food and Drug Administration has approved the use of these drugs to treat atherosclerotic cardiovascular disease, which includes heart attacks and strokes, and various inherited diseases. Research has demonstrated that the drug can reduce a patient’s risk of heart, stroke or cardiovascular death by 20 percent.

However, 43 percent of patients – 34,459 people – who need these drugs were denied coverage between July 2015 and 2016, resulting in 80,775 claims and 12,108 appeals.

Of national health plans receiving a large number of claims for these treatments, those with the highest rates of rejection included Express Scripts, Anthem and Cigna Healthcare.

On the plus side, those with the lowest rates of rejection were Rite Aid and Aetna.

The Institute for Patient Access also looked at rejection rates on a state-by-state level. Among the worst were Alabama, California, Florida and Texas.

Barriers to patient access include prior authorization requirements and other means. You can learn more in this video from the Alliance for Patient Access.


You can read more about the report cards by clicking here, or by visiting the Partnership to Advance Cardiovascular Health on Facebook.