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MESSAGE FROM THE PRESIDENT

Below is an OPED published at The Washington Examiner

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Why is the AARP missing in action on 'step therapy?'

by MARK GIBBONS

AUGUST 9th, 2019

Why is the largest consumer advocacy organization sitting on the sidelines as new federal rules make it harder for patients to get the vital medicines they need? That’s the question every senior should be asking AARP, and the organization’s lucrative business interests help shed light on a likely answer.  AARP promotes itself as a simple advocacy group looking out for the interests of older Americans. In reality, AARP is a marketing machine with longstanding ties to the insurance industry.
The nonprofit group (ahem) generated $1.6 billion in revenue in 2016, according to its most recent tax records. More than half of that total came from royalty payments it received from other entities that use the AARP brand and sell products to the group’s 38 million dues paying members.  The biggest benefactor of this cozy relationship is UnitedHealth Group. The insurance giant markets Medicare Advantage and Medicare prescription drug plans to seniors with the AARP stamp of approval. These insurance products are some of the biggest sellers in the Medicare system, and AARP profits each time a senior buys one.  It’s in this context that AARP’s stance on harmful new rules affecting seniors is so troubling. The Trump administration recently announced a policy that will force some patients in Medicare Advantage to suffer through the arbitrary rules of insurance companies before they can take the medicines their doctors prescribe.
The policy, known as “step therapy,” requires patients to fail first on a drug chosen by their insurance company, before the health plan will cover the medicine their doctor believes is best. It is an egregious practice that allows insurance executives to come between patients and their doctors, and the change in policy could result in dangerous side effects and diminished health outcomes.  It makes sense, then, that UnitedHealth would endorse this rule because it empowers the insurance industry, but it makes no sense for AARP members. In fact, the directive contradicts one of AARP’s principle policy tenets.
In its policy book, the group explicitly argues that patients should have access to the medicines their doctors decide are medically necessary. That simply won’t be the case for many seniors in Medicare Advantage health plans that adopt a fail first approach. The pain will be particularly acute for those who take medications for serious, often life-threatening, conditions, such as cancer, autoimmune disorders, and hemophilia. This practice has become all too common in the commercial insurance market, and the results have been devastating for patients.
One patient was forced to spend five weeks in a hyperbaric chamber after an infection in the leg spread to other parts of his body. The insurance company insisted on a certain medicine the patient’s doctor knew would be ineffective. Only after several months of phone calls from the patient’s wife did the insurer finally cover the medicine his doctor had prescribed.
A boy from Georgia endured excruciating pain and loss of appetite due to colitis, a chronic disease that causes inflammation in the digestive tract. The boy’s doctor found what his mother described as the “miracle pill,” only to be told by their insurance provider that he would have to take a less-costly drug before he could “step up” to the one that worked.
Adding insult to injury, the administration’s new policy doesn’t require insurance plans to notify patients that the drugs they need might be subject to this requirement. Other patient protections are missing, such as guaranteed access to an appeals process should patients want to contest their insurance companies’ decisions. Ellen Albritton, a senior policy analyst with the healthcare advocacy group Families USA, has warned the rule change will create “more barriers between patients and the drugs they need to stay healthy and live.”
Chris Hansen, president of the American Cancer Society Cancer Action Network, has said that “cancer patients should not be forced to ‘fail first’ on a drug that is known not to work for them before they are allowed to take the recommended treatment.” These and other patient advocates rightly recognize that adopting fail first policies in Medicare is not about encouraging competition. Instead, it’s about insurance companies rationing care. Seniors expect AARP to fight for their interests, yet it is completely absent from the fight against this misguided policy decision.
Since AARP’s founding, Congress has investigated the disconnect between AARP’s advocacy and marketing objectives. Is it an advocacy group, or a for-profit venture masquerading as an advocacy organization? This is an important question, and seniors deserve an honest answer. They pay their dues because they trust AARP to fight for their interests. AARP is betraying that trust as it sits on the sidelines and allows a rule to go through that will restrict access to the medicines seniors need.
Mark Gibbons is president of RetireSafe, which is dedicated to ensuring that legislative agendas protect the quality of life and economic well-being of older Americans while supporting common-sense solutions to the challenges of the future.

 

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