NPC in Specialty Pharmacy Times: Inconsistent Specialty Pharmaceutical Coverage Threatens Care Coordination, Continuity

Dan Leonard

Specialty pharmaceuticals hold much promise for treating patients with chronic diseases, from Crohn’s disease to cancer, from hemophilia to HIV. But inconsistency in insurance coverage decisions, combined with churn in the U.S. insurance marketplace, threatens the care coordination and continuity that renders these treatments most effective.

In his latest column for Specialty Pharmacy Times, NPC President and Chief Executive Officer Dan Leonard explores research published in Health Affairs that sheds light on when and how payers cover specialty medications. The research shows that specialty medication coverage can vary widely between commercial health plans, which can leave patients unable to access the specialty medications they need.

Mr. Leonard writes, “In this time of enormous development of specialty pharmaceuticals, reimbursement and patient access are crucial to achieve treatment benefits. Yet this research has important implications for patients and providers. For individuals looking to change health plans or employers, what is covered on one plan may not be covered by another plan. The switch in plan coverage may affect access to treatment and cause care disruption. Further, it places pressure on physicians, who must tailor care not just to the patient’s clinical presentation but also to the patient’s insurance coverage.”

Read more about how restrictions and variations in specialty drug coverage within commercial health plans can impact patients, and how we can address these issues, in Mr. Leonard’s Specialty Pharmacy Times column.