National Psoriasis Foundation submits letter to President Obama

On January 29, the National Psoriasis Foundation sent the following letter to President Barack Obama through his Web site, www.whitehouse.gov. The letter asks President Obama to reform harmful and discriminatory health insurance practices, especially those that affect the millions of Americans living with psoriasis and psoriatic arthritis.

On behalf of the National Psoriasis Foundation and the estimated 7.5 million Americans who live with psoriasis (a chronic, painful, and often disabling autoimmune disease) we are writing to urge President Obama and his advisors to ensure people with chronic health conditions have access to the care they need and deserve.

Almost half of all U.S. citizens—an estimated 133 million people—are living with at least one chronic disease, such as psoriasis. While the national debate on health care understandably focuses on the millions of Americans without insurance, there are millions more who have insurance but are considered underinsured because they cannot access the particular treatments, therapies, and other care their health care providers determine they need. This obstructed access to care stems principally from burdensome practices, policies, and coverage limitations by health care insurers. Without adequate care to manage their diseases, people with a chronic condition are at risk for increased health complications that can result in disability and/or unemployment—serious social and economic issues that adversely impact our nation.

The National Psoriasis Foundation is committed to supporting policies and programs that ensure people with chronic disease obtain the care they require to live healthy and productive lives. To that end, we respectfully call upon President Obama to include in his plan for health care reform, policies that eliminate the following harmful and discriminatory health insurance practices, policies, and coverage limitations:

Rapidly rising consumer out-of-pocket expenses: In the past decade, responsibility for health care costs has moved from a traditional shared risk model to one where the individual is expected to pay a significant portion of his or her health care. Out-of-pocket costs such as co-payments (co-pays) premiums and deductibles are rising at an alarming and unsustainable rate—far exceeding inflation. As a result, 25 percent of Americans report having a "serious problem" paying for basic health care, according to the Kaiser Family Foundation.

Prior authorization requirements including "step therapy": Prior authorization policies require that the patient meet a set of criteria or go through a complicated process before he or she is approved for a provider-prescribed medication or treatment. This includes step therapy, a practice which demands a patient try—and fail—a sequence of treatments or medications before the insurance company will approve the treatment that was originally prescribed to the patient. Patients are often required to complete the step therapy process even though the medication or treatment has contraindications, harsh side effects, or failed to work for the patient in previous attempts. In these circumstances, the health insurer is trumping the health care provider's judgment and forces the utilization of therapies that may be inappropriate. This practice wastes scarce resources and delays patients' access to relief.

Physician tiering: Some insurance companies "tier," or categorize physicians based on the cost of the medications they prescribe rather than the quality of the care they deliver. Patients of physicians who prescribe more expensive medications are charged higher co-pays. With tiering, a patient is forced to choose between paying more out-of-pocket to see his or her current provider or go to a "preferred" physician who may not have the same depth of knowledge about treating the patient's disease.

Health care rationing: Many patients have their insurance coverage rationed when the company decides to cover a particular treatment or medication for a set time frame, such as six months or one year. Rationing occurs even if a patient's disease is chronic and may have symptoms that require ongoing treatment. Insurance companies will also ration health care by requiring patients to have the disease symptoms for a period of time before prescribed medications are approved for use.

Defining specialty drugs as "tier four": A growing trend among insurance companies is to place specialty drugs, such as the biologic drugs used to treat various inflammatory diseases, into a higher drug formulary category under which greater payments are required. These specialty drugs are often the safest and most effective treatment for many types of chronic diseases; however, patients are charged more out of pocket to access them. By denying the patient access to specialty medications, the insurance companies deny patients access to relief from the symptoms of their disease.

Through cost shifting, onerous policies and procedures, rigid requirements, coverage limitations, and massive bureaucracy, insurance companies are allowing people to become—and remain sick—in short, to suffer. As we know first hand from the millions of Americans we represent, each of the aforementioned policies/practices threatens the health and well-being of people with psoriasis. By reducing and, in some cases, prohibiting access to medically necessary care, these health insurer practices increase out-of-pocket expenses for individuals and businesses, reduce patient quality-of-life, and elevate the risk for complications, adverse health outcomes and/or permanent disability for individuals with chronic disease.

We thank you for your consideration of our concerns and encourage President Obama to ask Congress to send him health reform legislation that eliminates these and other barriers to care for people with chronic conditions.

A healthy nation starts with healthy citizens. On behalf of the National Psoriasis Foundation, we thank you for your attention to our concerns and for helping to ensure that the 133 million Americans with chronic disease, including people with psoriasis and psoriatic arthritis, have access to the health care they need and deserve to live fuller, more productive lives. Please know that we stand ready to work with you on these and other important access to care issues.