Policy & Access to Care
Today’s health care landscape is complex. Patients, doctors, hospitals, insurers, the government, and numerous other health care stakeholders are each seeking ways to improve the system to their benefit. Often, these efforts work against others in the market.
If individuals living with diseases like psoriasis and psoriatic arthritis are not actively participating in these discussions, the result may be that health care stakeholders design policies that do protect patient access to therapies or positively influence health outcomes. NPF works on behalf of our communities – and alongside other patient communities – to support benefit design and coverage polices that offer meaningful access to cost-effective, clinically appropriate treatments.
Key Policy Initiatives
NPF’s Government Relations & Advocacy department has worked to enhance dialogue with those who shape and influence coverage polices including payers and related parties and employers. In January 2016, the NPF assembled a day-long payer advisory panel comprised of a half dozen payers or related experts as well as NPF patient advocates and key medical and clinical experts. The aim of this panel was to promote dialogue between these stakeholders to advance the collective understanding of the challenges of living with and treating psoriasis. More recently, in February 2017, we convened an initial discussion involving representatives from employer and related organizations to gather additional perspectives on benefit design and related issues. These sessions underscore our deep existing interest in being a true leader in this space.
In 2016, the Institute for Clinical and Economic Review (ICER) conducted an assessment of psoriasis therapies. The NPF had a team of staff, patients, and clinicians who connected early and often with ICER. As a result of the NPF’s engagement in the ICER value assessment on psoriasis, ICER reshaped the scope of the assessment to focus solely on psoriasis, dramatically adjusted its final report conclusion to reflect all eight of the reviewed therapies being of “good value” and recommended that insurers consider “limiting or abolishing” the use of step therapy for individuals living with psoriasis. This was a significant evolution – particularly given the draft finding of only one therapy being of good value - and demonstrated the impact a patient advocacy organization could have on both the policy recommendations and the pure economic portion of a value assessment.
According to ICER, “Through our interactions with NPF, we learned things that made the report more accurate and actionable. They highlighted the difficulties with step therapy and prior authorization that patients with psoriasis face. They emphasized how much the side effects of the disease can affect a patient’s day-to-day life. They truly helped us gain insight into what it’s like to live with psoriasis- acknowledging, of course, that every patient’s experience is a little different.”
1 | “Including the Patient Perspective.” ICER. January 4, 2017.