111th Congressional Positions |
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National Patient Advocate Foundation actively supports public policy initiatives that improve access to healthcare. The Federal Government Affairs Program works collaboratively with other organizations to assure access to quality healthcare by: providing development and guidance on healthcare policy for the U.S. Congress, the White House and government agencies; conducting research through the Global Access Project (GAP) established in 2004; and conducting briefings for members of Congress and staff. NPAF has outlined its legislative position statements for the 111th Congress:
Archived Statement of Principles Statement of Principles on Catastrophic Health Care CostsNPAF has identified catastrophic health care costs as a critical issue of concern. NPAF believes that meaningful health expansion and reform will not be possible without dealing with high-cost patients in a new and innovative way and limiting the amount of cost-shifting with which patients have been burdened over the last several years. Statement of Principles on Medical DebtA growing number of individuals and families are finding that they cannot afford health coverage due to rising premiums, deductibles, co-pays and coinsurance obligations in combination with accelerated use of caps on specific services, caps annually on specific disease benefits, and caps on lifetime benefits. NPAF believes coverage should be available that is affordable for individuals, families, businesses and government. A recent report by The Commonwealth Fund, found that nearly 41% of adults age 19 to 64 (approximately 70 million people) experienced problems paying their medical bills in the last 12 months or were in the process of paying off medical debt accrued over the last three years. Study participants also said they were forced to make significant life changes in order to pay such bills, or went without necessary care. In addition, it is estimated that more than one half of all bankruptcies are caused primarily by medical debt. The bankruptcy law that went into effect October 2005 implements a "means test" requirement that will be used by the courts to determine eligibility for Chapter 7 or Chapter 13 bankruptcy. Means testing is an investigation into the financial well-being of a person. For individuals with medical debt, means testing may increase the level of financial distress they are already experiencing because the new bankruptcy rules will force many individuals to file Chapter 13 because the means test takes into consideration the person's income. Under Chapter 13, debtors must pay back a significant portion of their debt within a short time period instead of having their debts excused under Chapter 7. NPAF supports reforming current bankruptcy laws to allow debtors to file medical debt. Statement of Principles on Health Information TechnologyNational Patient Advocate Foundation supports the rapid deployment of health information technology (IT) and wishes to ensure that patient concerns including privacy and security safeguards are considered in the development of health IT policy, standards and innovations. Health IT remains a critical issue relative to both health care access and quality. NPAF supports widespread adoption and use of health IT to help reduce the nearly 100,000 deaths that occur each year due to medical errors. The U.S. Department of Health and Human Services has estimated that adoption of health IT could reduce health spending by as much as 30 percent annually. In addition, health IT would improve the quality of care, reduce duplicity, and increase medical efficiency for patients. As a member of the Health IT Now! Coalition, which unites patients, practitioners and employers, NPAF supports federal legislation to promote a connected health IT system. NPAF supports the following Coalition principles:
E-prescribing An issue related to HIT, e-prescribing, is cost-effective, provides immediate access to information, improves medication management and provides for safer care. NPAF supported language included in the "Medicare Improvements for Patients and Providers Act of 2008" (MIPPA) which mandated e-prescribing under Medicare and encourages further adoption of e-prescribing for non-Medicare providers. Again, NPAF would like to emphasize the importance of incentives for providers, especially those serving underserved and high-risk populations, who may struggle to adopt this system. Collaboration with Patients in the Development of Health IT. It is critical that the consumer/patient voice be considered and heard as health IT innovations are developed and that this perspective is integral to the development of national policy. NPAF will continue to represent patients as part of the Health IT Now! Coalition to ensure that this perspective is integral to the development of national policy. Additionally, NPAF will continue to urge patient appointments to committees directing these efforts in the government and private sector. Interoperability. It is important to develop a national health IT framework that will be interoperable throughout the country so that hospitals, clinics, doctors, public agencies, and other entities are not each investing in creating redundant systems that are unable to communicate effectively with other systems. These systems must be affordable, devoid of redundancy and must address gaps in the continuum of health care delivery. Health savings would also result from accurate, portable patient records that would reduce the number of repeated tests and procedures. Electronic medical records, personal health records, e-prescribing and other IT tools could also result in quality improvements based on a reduction of secondary adverse reactions and medical errors resulting from contraindicated drugs, treatments or therapies or unclear handwritten prescriptions or records. These IT tools must be certified, work well, not be burdensome, and serve as a resource that adds to efficiency to incent utilization. Statement of Principles State Children's Health Insurance ProgramNational Patient Advocate Foundation remains extremely concerned with the growing number of Americans who lack any health insurance coverage, especially children. According to the U.S. Census Bureau, the number of uninsured Americans was 45.7 million in 2007, down from 47 million in 2006. The number of uninsured children under age 18 was 8.1 million in 2007 (approximately 11 percent) the majority of which come from low or middle-income families. According to the Kaiser Family Foundation, "more than two-thirds of the 8.1 million uninsured children in the U.S. live in families with household incomes below 200% of the federal poverty level ($42,406 for a family of four in 2007). Nearly all of these children (approximately 6.2 million) are eligible for Medicaid or SCHIP but not enrolled. The State Children's Health Insurance Program (SCHIP) was created in 1997 as part of the Balanced Budget Act. Through SCHIP, the federal government gives each state a pool of money to be used to provide uninsured lower-income children with health insurance. SCHIP is intended to supplement the Medicaid program by providing coverage for low-income children whose family incomes are too high to quality for Medicaid but whose families cannot afford private health insurance. Combined, Medicaid and SCHIP provide coverage for approximately 25% of all children in the United States. National Patient Advocate Foundation strongly advocates for the reauthorization and expansion of the state children's health insurance program (SCHIP) in order to preserve the gains made in children's health since its inception in 1997. National Patient Advocate Foundation supports expanding SCHIP to cover all children below 300% of the federal poverty level. SCHIP has been successful at expanding health coverage to lower-income children and improving the health care they receive. According to the Government Accountability Office (GAO), as of fiscal year 2005, SCHIP covered approximately 6 million enrollees including about 639,000 adults. A recent Kaiser Family Foundation report explores our current economic downturn and the anticipated effects on our uninsured population. Under existing circumstances, a strong reauthorization of SCHIP is critical to provide access to critically important health services to uninsured children. Improving the development of outreach efforts to promote SCHIP enrollment is also a critical element in reducing the number of uninsured children. NPAF supports national and state strategies to further develop outreach methods that link together schools, community-based organizations, non-profits, health care providers and private business groups to reach eligible but un-enrolled family populations and retain existing enrollees. Statement of Principles on Comparative Effectiveness ResearchAs an advocate for America's patient community, National Patient Advocate Foundation supports the development of research on the comparative clinical effectiveness of the multiple treatment options for those with chronic, debilitating and life-threatening conditions, in order to educate individuals on the options available, and to better equip them for the decisions they must make with their physicians regarding the best course of action in treatment. NPAF acknowledges that, in the cases of certain conditions and illnesses, there is a limited amount of evidence available on which treatments work best for which patients. These knowledge gaps have presented an opportunity for an expanded federal role in the study of the comparative clinical effectiveness of various medical interventions. Background. In weighing the options for an expanded federal role in the study of comparative effectiveness, we must define "comparative effectiveness" ("CE") as applied in the health care sector. Comparative effectiveness research is broadly defined as the comparison of the various impacts of different options that are available for the prevention, detection and/or treatment of a given medical condition, for a particular set of patients. These studies might be comparisons of similar treatments, such as competing drugs indicated for the treatment of the same condition, or they may analyze different approaches to care, such as surgical intervention versus a less-invasive procedure, or pharmacotherapy. The analysis should focus on measuring the relative medical benefits and risks of a given treatment, inclusive of enhanced quality outcomes for the patient, to determine which patient populations would have the most to gain from a particular medical intervention. While some information regarding the effectiveness of a new drug, device or procedure is often publicly available, rigorous comparisons of the different treatments are far less common. NPAF believes that all health care decisions should be informed by the best scientific and clinical evidence available. In order for patients to take responsibility for their health and become actively involved in informed decision-making with their personal physicians, they must be armed with the best available evidence regarding the condition and its methods of treatment. A national comparative clinical effectiveness research entity in the U.S. could have the potential to create a more centralized approach to the coordination of research and its findings, enhancing the safety and quality of care, while improving clinical practice and delivery, and possibly leading to the genesis of new areas of research and scientific discovery. Patient Needs and Personalized Care. It is of the utmost importance that this research be performed for the purpose of improving the quality, safety and delivery of care, not to limit access, deny treatment or reimbursement. While CE studies will help to inform health care decision-making, NPAF strongly urges that the findings should not over-look subpopulations that may benefit from a particular treatment, or neglect the needs of patients for whom the findings are not necessarily supportive which may include patients with multiple co-morbid, complex conditions. Physicians must have the latitude to define appropriate, personalized medicine. Health care decisions should continue to be tailored to fit an individual's needs, where CE research should inform, but not dictate, the patient's treatment options. Organization and Funding. Any established entity intended to perform such research would need to be structured to ensure the highest level of accountability and credibility, while maintaining functional autonomy and operating free from external political pressures. The choice of organizational arrangement, as well as a funding mechanism, will have a great impact on the entity's direction, independence and accountability. NPAF would support the establishment of a new body, obtaining its funds from both federal appropriations and pre-established contributions from sources within the private sector. This entity would coordinate research priorities, while allowing academic institutions and research centers throughout the country to perform reviews on a set of previously determined conditions and interventions. This process would eliminate inherent conflicts that may exist between the mission of existing federal agencies and that of a proposed independent entity. Stakeholder Participation. It is essential that the composition of the steering organization of the research entity consists of all relevant stakeholders, including patient and consumer groups, representatives from the public and private sectors, such as government, physicians and other health care providers, medical specialists, insurers, and manufacturers of drugs and medical devices. These stakeholders should be involved in every step of the process, from setting the research agenda, and developing study methodology, to the translation and dissemination of findings. The stakeholders must have no conflict of interest and certify the same. Scope, Selection and Prioritization of Research. Comparative effectiveness research should encompass all aspects of medical treatment, from standard methods of prevention, screening and diagnostic testing, to drug therapies, procedures and surgical interventions, to the use of medical devices. Focusing on the full spectrum of available approaches to care will encourage the ideal of a patient receiving the right care, at the right time, in the right setting enhancing quality outcomes. Given the vast array of possible research topics, the earliest studies should be selected and prioritized by stakeholders including patients, providers, and researchers. Initial activities should be focused on conditions with significant impact on overall national health. For example, priorities might include the multitude of treatments for commonly occurring conditions such as obesity, heart disease, diabetes, or cancer. Research on these subjects is likely to have a wealth of information available for review. However, in these fields there may also be a great amount of confusion surrounding the relative benefits and risks of new technologies in comparison with the older standards of care. Special patient populations, including minorities, should be integrated into comparative effectiveness research. NPAF is concerned that under our current system, the majority of clinical trials lack a balanced representation of minority populations who could be unduly burdened as a result of decisions made through comparative effectiveness research that did not include data relative to clinical research for these populations. Comparative effectiveness guidelines should only apply to those populations that have been included in the research. Chronic conditions are often associated with a disproportionate cost burden due to the extensive and prolonged course of treatment, while some conditions simply carry a higher price tag because of costly treatments required (e.g. radiation and chemotherapy). These areas deserve special attention from researchers when setting priorities, but once the research agenda has been established, cost should not be used as a measurement in evaluating the comparative effectiveness of a product or procedure. The prioritization of the research process is the only point at which NPAF believes cost should be taken into consideration. Use of Research Findings. NPAF acknowledges that an inherent long-term goal behind the study of comparative effectiveness is to reduce overall expenditures on health care in the United States; however, we believe that it should only do so through the improved management of health care delivery (e.g., by reducing waste and misuse, defining appropriate interventions and encouraging physician best practices). We do not support the research entity in question using CE research to determine cost-effectiveness of a given treatment, and we are opposed to the use of these findings in coverage and reimbursement decisions. Findings should be used solely for informing patients and physicians as to what treatments offer the most benefits with the fewest relative risks, thus improving, not impeding, good clinical practice. Transparency and Dissemination of Findings. In order to best serve payors, clinicians and patient populations, research findings should be translated in a manner suitable for their respective audience. Information should be summarized and described in detail as to inform medical professionals, but should also be made available in a clear manner to be easily managed by the average patient. The process should be transparent from beginning to end. Statement of Principles on Physician ReimbursementNational Patient Advocate Foundation is concerned that reductions in Medicare physician payment may adversely affect patients. Last year, 22% of patients contacting Patient Advocate Foundation (PAF) were insured through Medicare. Within the PAF Medicare population, 56% were aged while 44% were disabled individuals. In addition, 41% were male, and almost 72% had a cancer diagnosis. Because PAF serves such a large number of Medicare beneficiaries, cuts to physician reimbursement are especially troubling since decreased reimbursement to physicians will ultimately lead to decreased access to necessary care for patients. In addition, physicians will have less incentive to treat Medicare beneficiaries if future cuts to reimbursement are implemented. This will lead to some physicians deciding not to accept any Medicare beneficiaries at all which is particularly troubling for patients living in rural settings that may already have limited access to healthcare providers. Further, the PAF Medicare patient population tends to live on a fixed income - nearly 75 percent of PAF Medicare patients have incomes of less than $23,000, and one-half are over 65. They face challenges with meeting both the coverage gap associated with Medicare Part D, as well as the 20% out-of-pocket expenses incurred with the delivery of any healthcare service reimbursed under basic Medicare coverage. Over the past several years, Congressional action has blocked scheduled physician reimbursement cuts from going into affect. Temporary fixes are not an effective or efficient way to address physician reimbursement; a long-term solution needs to be adopted to fix the flawed Sustainable Growth Rate (SGR) system. A 2007 American Medical Association ("AMA") survey suggested that 60% of physicians would have been forced to limit the number of Medicare patients they treated had the January 2008 10.1% payment cut gone into effect. Also, between now and 2015, eight in ten physicians said they expect to reduce or delay purchases of new and innovative medical equipment and/or more sophisticated information technology if cuts to reimbursement occur in the future. Sustainable Growth Rate. Sections 1848(d) and (f) of the Social Security Act (the Act) require the Secretary to set the physician fee schedule update under the Sustainable Growth Rate (SGR) system. Based on this update system, as discussed above, CMS anticipates further negative updates in later years, absent further Congressional intervention and a revision of the SGR. NPAF continues to be concerned that the SGR is problematic as it results in negative updates that can impact poorly on patient access. The SGR formula fails to consider other factors affecting the actual cost of providing physician services such as growth in the beneficiary population, program changes and utilization factors unrelated to economic trends. NPAF suggests that Congress work with all national healthcare stakeholders to restructure this reimbursement calculation system so that patients' needs, which do not diminish in slower economies, are met and to ensure that fee schedule payments increase annually to reflect real increases in the cost of providing patient care. NPAF also asks that CMS be vigilant in watching for potential indicators of pending access problems such as reductions in chemotherapy claims volume and intervene appropriately to reverse those access issues. NPAF will continue its association and collaboration with members of the provider community to monitor access issues and to intervene appropriately. Nationally, the research through NPAF's Global Access Project (GAP) is tracking and reporting access issues. Statement of Principles Prescription Drug Price Negotiation / NoninterferenceBackground The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) established a prescription drug benefit for Medicare beneficiaries under Medicare Part D, beginning on January 1, 2006. The MMA's "noninterference" clause prohibits CMS from interfering with drug price negotiation between manufacturers and Medicare drug plan sponsors and from instituting a formulary or price structure for prescription drugs. The framework created by the MMA attempts to lower drug prices though competition. Part D plans are expected to negotiate prices and/or rebates with manufacturers and compete for enrollees by passing on the savings through lower premiums and cost-sharing requirements. Those unhappy with the savings achieved under Part D want to repeal the noninterference clause so CMS can actively attempt to negotiate lower drug prices with manufacturers. Principles NPAF is concerned that repeal of the noninterference clause may hamper the development of new drug therapies and lead to widespread adoption of restrictive formularies that inappropriately limit access to newer or more expensive treatment options. Additional savings to the federal government must not be achieved at the expense of patient access to medically appropriate therapies. Drug Innovation -While there is disagreement over the relationship between pharmaceutical R&D and the introduction of new drugs, a recent study concluded government-mandated price negotiations would reduce the number of life-saving drugs developed each year by about a dozen and "yield a loss of 5 million life-years annually," an adverse effect valued at > $500 billion/year. Access to Reasonably Priced Drugs-As of mid-2006, almost 40% of Medicare-eligible veterans with VA benefits were enrolled in Part D, a fact believed to reflect a desire by veterans to avoid the VA's restrictive formulary. If a federal formulary were to become a de facto national formulary used by the majority of Part D and commercial plans, it could severely restrict access to unlisted drugs and potentially lengthen the time required for innovative products to achieve covered status. Patients would be forced to pay out-of-pocket for unlisted drugs. If discounts are negotiated by the federal government, drug companies may respond by increasing the prices charged to other buyers thus shifting the Medicare burden to employers and commercially insured individuals. Statement of Principles Value-Based PurchasingBackground. "Value-based purchasing" is a term used to describe a health care provider reimbursement methodology that integrates provider performance and payment incentives into reimbursement and fee-schedule determinations. Under value-based purchasing policies, reimbursement rates are determined based on providers' performance as evaluated pursuant to quality-related standards, as laid out by plans, to meet pre-established targets for delivery of a wide range of health care services. This payment model seeks to reward physicians, hospitals and other providers for meeting certain measures of quality and efficiency for medical care they provide. Quality Improvements. National Patient Advocate Foundation favors value-based purchasing methodologies designed to offer incentives for the delivery of high-quality care, rather than penalizing those services that do not meet the prescribed standards. However, NPAF does recognize that "never-events" are an exception in a value-based system. Provider reimbursement should not be reduced under a value-based purchasing system; physicians, for example, should not be dropped from a plan because they provide more costly services to patients in relation to other providers. Payment reductions based on performance evaluation would make services even more inaccessible for patients, as disincentives may reduce the availability of eligible providers. In contrast, we believe that incentives that encourage improved quality of care delivered would be a benefit to both patients and providers. We therefore recommend that these reimbursement systems be compensatory in nature, not punitive. Patient Access. As this payment methodology becomes more prevalent, NPAF will seek to ensure that the needs of patients are addressed. NPAF believes that implementation of a value-based purchasing system of quality measures would support both improvements to beneficiaries' quality of care, as well as the implementation of appropriate reimbursement updates, but must be structured to provide incentives for high-quality care. For instance, payments should not be directly linked to outcome improvements, as this may negatively impact a physician's willingness to treat high-risk patients or those with inevitable or irreversible outcomes. As value-based purchasing models develop, it is imperative that patient access to quality care be facilitated and that standards of quality outcomes reflect the latitude of changes in disease status that contribute to debilitation even with quality care. Need for Adequate Reimbursement. As an advocate for America's patient community, NPAF recognizes that adequate reimbursement for professional services is an essential component to ensuring patient access to care. NPAF also recognizes the need for maintaining strict safeguards to protect the safety and well-being of health care consumers. Implementing performance-based programs may contribute to appropriate reimbursement standards and may likely advance the safety and quality of care and its delivery. Development of Performance Standards and Stakeholder Participation. A number of parties within the health care sector support the use of incentive programs to improve the quality of health care, however some have expressed concerns with the development and legitimacy of quality indicators, increased administrative burdens, physician autonomy and the rights and privacy of patients. Therefore, NPAF urges policymakers to include all stakeholders in a collaborative process to develop appropriate evaluation standards. We also urge that standardized and consistent quality-related measures be developed and adopted by all stakeholders to ensure the programs' integrity and maintain the best interests of the patient population. We also note the importance of developing distinct standards to evaluate performance relative to our most vulnerable patient populations including: Medicare beneficiaries; disabled; and those suffering from chronic, debilitating and/or life-threatening illnesses. Quality Indicators and Standards. As noted above, standardized and consistent quality-related measures are critical if value-based purchasing programs are to meet the intended goal of improving the quality of care. A system that evaluates performance as it relates to cost, volume or efficiency is all too often contrary to patient needs and access to quality care. Policymakers must carefully consider how "quality of care" will be defined, measured and evaluated including a process to assure attention to the management of pain, nausea, and mobility. Patients define independent living as a primary goal in disease management and the primary standard for defining quality. It is important to recognize that the term "quality indicator" could be used to describe indicators that result in determinations that overly expensive care has been provided, as well as indicators that result in determinations that the provided care could be harmful to the patient's well-being. These two concepts are quite different and must be addressed prior to implementation. Data Collection and Reporting Costs. NPAF is concerned that the collection of such data should not be overly time-consuming, resource-intensive, expensive, duplicative or otherwise burdensome so as to discourage provider participation. We recognize also that the cost of compliance and participation is likely to include information system or software investments as well. It is important that any legislative proposals include provisions for incenting or subsidizing physicians in obtaining the technology needed to participate in a value-based purchasing program. We also encourage that data collection requirements be developed in consideration of the variable accessibility of different types of data and recognize, for example, that administrative or claims data may be easier to collect and report than encounter data. NPAF supports the development and use of interoperable electronic health infrastructures that will facilitate collection, transmittal and evaluation of performance-related data without creating a financial or labor burden for providers, which, subsequently, would threaten patient access to care through diminished resources and professional staff. Patient Choice. Finally, NPAF recommends that the performance ratings for each provider measured across all payor types be made available publicly in order to ensure transparency and assist patients in selecting a provider. Patients make the greatest investment in any healthcare transaction and ultimately it is the patient who entrusts their life to physicians. A system of informing the public of physician performance ratings will encourage utilization of those most qualified physicians and will hopefully lead to more qualified physicians. Statement of Principles Follow-on BiologicsWhere We Stand National Patient Advocate Foundation actively supports legislation and regulations that protect patient safety and increase patient access to effective low-cost biotechnology therapeutics. Patient safety should stand at the center of a regulatory approval pathway for follow-on biologics. Background Chemical drugs are typically made by mixing together well-defined chemicals in controllable "recipes" following the formulas and the predictable rules of organic chemistry. The same final product can sometimes be obtained through a very different process, and the product can be analyzed in a laboratory to confirm that it is exactly what it is supposed to be. It is a relatively straightforward exercise to show that a generic chemical product is the same as a branded product. Evidence from clinical trials is not necessary, and cannot be submitted in an application for a generic product. Biologics are more complex molecules than chemical drugs; they are not manufactured through chemical synthesis but instead are made by genetically engineering living cells to become miniature factories producing the desired molecules (proteins). These living cells are inherently variable and susceptible to slight changes in their environment that can significantly alter the proteins they are engineered to produce. Because no two living cell lines are identical, no two biologics manufacturing processes have identical starting materials or proceed in the same way. A follow-on biologic manufacturer that uses different starting materials and a different process will produce a product that is different from the innovative product. In addition, the complexity of biologics currently makes it impossible to show in the laboratory that a follow-on biological product will work the same as the innovator in patients. The effects of the difference between a follow-on biologic and its respective innovator product can only be determined by subjecting the follow-on to substantial clinical testing in patients to prove that it is safe and effective. Because of the complex science involved, the Food and Drug Administration (FDA) has indicated that the generic drug approval pathway is not appropriate for complex biologics. With patents for a number of blockbuster biologics expiring in the next several years, Congress and the FDA are under pressure to establish an expedited approval pathway for follow-on biologics, thus paving the way for the development of a U.S. follow-on biologics industry. NPAF recommends Congress recognize and adopt the following principles as they explore the creation of a regulatory pathway for follow-on biologics:
Biopharmaceutical innovation can provide major improvement with respect to the quality and length of human life but could also exacerbate cost pressures and access disparities in health care. NPAF strongly urges Congress and the FDA to balance the objectives of innovation incentives and price competition as well as ensure patient safety. Statement of Principles on Fiscal Year 2010 Appropriations PrioritiesNational Patient Advocate Foundation supports federal programs that will advance biomedical research in cancer and other chronic medical conditions. We support programs that are designed to reduce or eliminate health disparities among minority and uninsured patient populations. NPAF also supports programs to assist with cancer screening, prevention, education, detection and treatment, as well as programs designed to study cancer epidemiology. National Patient Advocate Foundation supports the appropriation recommendations developed by One Voice Against Cancer (OVAC), a collaboration of national non-profit organizations representing cancer patients. As an OVAC member, NPAF urges Congress to appropriate the levels of funding recommended by OVAC for the National Institutes of Health, National Cancer Institute, Centers for Disease Control & Prevention, Food and Drug Administration, and Health Resources and Services Administration programs. OVAC appropriations recommendations are expected to be finalized in January 2009. Statement of Principles on Prescription Drug ReimportationThe high cost of prescription drugs poses a major threat to the health and safety of many Americans. National Patient Advocate Foundation and its companion direct patient services organization, Patient Advocate Foundation (PAF), receive requests on a daily basis from patients throughout the country who are having difficulty acquiring needed prescription drugs. In 2007, the primary issue PAF patients reported was pharmaceutical co-payment issues at 31%. Additionally, of patients reporting pharmaceutical issues, 33% reported inadequate or no pharmaceutical coverage. PAF receives requests from patients across the country seeking assistance with a variety of pharmaceutical issues including: acquiring drugs that are not included in health plan formularies; coverage and reimbursement for off-label uses of covered prescription drugs; inability to meet co-payment and other cost-sharing obligations; policy limitations and coverage caps; and assistance requests from patients with no coverage for needed prescription drugs. The greatest number of requests for assistance we receive is from patients who are unable to pay for needed prescription drugs. PAF resolves these cases through mediation and arbitration with health plans and employers and through the patient assistance programs established with the support of pharmaceutical and biotechnology companies. Patients are also given information regarding state and federal programs or other financial resources for which they may qualify, as well as assistance with expedited applications for benefits. Case managers also facilitate access to mail order pharmacy benefits or identify local pharmacies that provide the prescribed medication at a reduced cost. In total, 20% of PAF patients who reported encountering pharmaceutical related issues cited "no pharmacy coverage" as their primary pharmaceutical access issue in 2007. In addition, almost 16% of patients reported they had exceeded their pharmacy benefit maximum, and 13% had inadequate prescription drug coverage. As a patient advocacy organization, NPAF is concerned about the quality and safety of pharmaceutical products when they reach the consumer, regardless of where they are manufactured. A handful of states have established programs that allow citizens to purchase prescription drugs at lower retail prices from approved, foreign pharmacies. Each of these states has created an inspection process aimed to ensure that the foreign pharmacies are safe, reputable, and reliable. Since Americans generally receive very low cost generic drugs, often only brand name drugs are included in the state's reimportation program. National Patient Advocate Foundation looks forward to a time when the federal government is able to put into place a system of strict safeguards to guarantee the quality, safety, and authenticity of foreign pharmaceutical products. NPAF recognizes there are legitimate concerns with regard to the safety of foreign manufactured and/or reimported prescription drugs including the possibility of corrupt or counterfeit drugs entering the market or inadequate manufacturer inspection processes. NPAF believes there needs to be a federal process put in place that can assure the safety of foreign manufactured and reimported products. Finally, NPAF believes that the Food and Drug Administration (FDA) should be provided the necessary resources in order to implement a safe, reliable prescription drug reimportation program. Statement of Principles on Medical ImagingThe Deficit Reduction Act of 2005 (the "DRA") included dramatic cuts, approximately $8.1 billion, to payments for medical imaging services under Medicare and went in effect January 1, 2007. National Patient Advocate Foundation believes that medical imaging services, such as ultrasound, x-ray, CT scans, and MRIs, are essential tools to help detect, stage and treat life-threatening and debilitating diseases like cancer, stroke and heart disease. Medical imaging provides less-invasive evaluation and treatment protocols which often enhance the recovery process for patients. NPAF is concerned that cuts to medical imaging services disproportionately impact access to care for patients living in rural and underserved urban communities. The impact of these cuts on patients is immediate and harmful. While NPAF is acutely aware of recent reports of over-utilization of imaging services by providers and supports efforts to remedy this finding, NPAF strongly opposes any new cuts to medical imaging and supports the following principles. Medical imaging saves lives. Medical imaging enables better, less-invasive care which often means easier recoveries and greater patient comfort. Medical imaging often detects critical illnesses at their most curable stage when they are also least costly to treat. The majority of cancer patients served through Patient Advocate Foundation require multiple forms of imaging. Medical imaging is cost-effective. Because of less-invasive care, fewer complications, earlier detection, shorter hospital stays, and better patient management, medical imaging is an overall cost-saver for patients and for the healthcare system in general. Because medical imaging helps keep workers healthy and on the job by helping avoid surgery, long recuperation and disability, medical imaging is good for the economy and the individual being served. Medical imaging is the future. Medical imaging technology provides physicians with a remarkable vision of the body's structure and functioning without surgery and is one of the essential tools of modern medicine. Medical imaging is a core component of the digital revolution enabling productivity gains through electronic health records, rapid access to images, and greater information and flexibility resulting in better outcomes for patients. |
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Learn about NPAF's positions on comprehensive health care reform for all Americans.
