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Our government plays a critical role in the health of our nation. It funds large-scale medical research projects, manages entitlement programs such as Medicare and Medicaid, and crafts laws that support and promote access to care. For these reasons and more, it’s important that our lawmakers understand the health needs of people living with eczema.
NEA has a three-pronged approach to advocacy:
Eczema is a serious inflammatory disease that has a significant impact on the lives of those dealing with the condition. This is known as “burden of disease.” NEA works to raise awareness with lawmakers about the realities of life with eczema including:
We believe what treatment you use to manage your eczema is a decision that belongs to you and your health care provider – and to you two only.
NEA works to control health insurance cost-cutting measures that interfere with you and your doctor’s ability to make the best choices about your health. These include:
Also known as “fail first,” step therapy requires a patient to try and fail another (usually less expensive) drug before the insurer will cover the medication originally prescribed by the doctor.
NEA Policy Priority: Work with health insurance companies to amend step therapy requirements when the patient has already tried and failed the “step” drug, or the drug is not right for patient health either because of potential side effects or because the drug is ineffective for the patient’s type and severity of eczema.
Prior authorization requires your health care provider to get approval from your insurance company before prescribing a particular medication. This layer of administrative complexity adds an unnecessary burden on doctor office staff and slows down a patient’s ability access medication, delaying symptom relief.
NEA Policy Priority: Encourage legislation that requires insurers to use prior authorization processes which are standardized, easy-to-use and sensitive to the health needs of patients.
Non-Medical switching occurs when an insurer changes its formulary, the list of drugs that it covers, during the middle of a contract year and requires its members to change over to the new drugs instead of keeping them on the drugs that their doctors have prescribed. Some states ban health plan from mid-year formulary changes, but most do not.
NEA Policy Priority: Prohibiting insurers from requiring patients to switch to a new drug during the middle of a plan year, except for when a federal Food and Drug Administration (FDA) regarding a drug necessitates a change.
Scientific innovation has brought many new medications that are targeted and for many, effective in controlling disease symptoms. However, the cost of these “specialty drugs” are increasingly being passed on to patients by insurance companies in the form of higher co-payments. These higher out-of-pocket costs can make important, life-altering treatments out of reach for many people managing serious chronic diseases.
NEA Policy Priority: Advocate for the passage of state legislation that caps out-of-pocket costs (co-payments, coinsurance limits, and prepayment requirements) on specialty drugs.
Network adequacy refers to the size of a health insurer’s network of providers relative to the size of the insured population, and its ability to deliver covered benefits and services quickly and conveniently for policyholders. Most states have requirements in place but changes in federal and state law could erode patients access to the providers who manage their care.
NEA Policy Priority: Requiring insurers to maintain networks of providers which are sufficiently trained to meet the health care needs of their members impacted by eczema.
In 2016, the federal government spent $1.11 on research per every citizen with eczema. Considering the significant impact of eczema on the individual, the community and the society as a whole, NEA’s 2017 research priorities call for: