The Specialty Tier Coalition of Georgia Reengages to Improve the Lives of Seriously Ill Georgians

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The Specialty Tier Coalition of Georgia Reengages to Improve the Lives of Seriously Ill Georgians 

ARxC, partnering with the Specialty Tiers Coalition of Georgia (STCGA), has launched a new website, Rx in Reach Ga (www.rxinreachga.org ) to advocate for legislation that will bring down the high out of pocket costs of specialty/biologic drugs. These drugs are cutting-edge treatments that save lives and improve the quality of life for those suffering from serious chronic illness like Cancers, Rheumatoid Arthritis, Lupus, Multiple Sclerosis, Hemophilia, HepC, HIV/AIDS and other debilitating diseases.

Since 2012 we have been investigating why these special medications have such a high cost to the insured and how we can bring down the prices so all who need them will have medical and financial access to them. We have created the Rx in Reach GA site to educate and engage the public and professionals in this plight to reduce the cost of medications and increase their access to those who depend on these medications. We ask all Georgians to join us in advocating for legislation and a re-design of how all the interested parties ‘do business’. We are not economic experts. We are advocates who are experts at listening to the needs of patients and the barriers to care they face daily. We are also ‘problem solvers’ who believe there is always a better solution to be found and implemented when we come together as a community with a willingness to  hear the ideas and concerns of each stakeholder and advocate as one voice.

When 90 End Stage Renal Disease (ESRD) patients were told their only source of scheduled dialysis treatments would be taken away and they would be left to die within weeks, ARxC stepped in to give the patients a voice and find a solution. As we fought for the care of these uninsured patients, we created a community model that brought all the stakeholders to the table for discussion and established a standard of care directive that defended the right of patients to live as it restored their medical care. This model, the ARxC Community Action Plan (CACP), holds the promise to ‘do no harm and protect patients’ while taking actions that uplift the well-being of the community.

Initiating the principles of the CACP model put pressure on the hospital abandoning the dialysis patients and created a platform for idea exchange between the hospitals, physicians, patient advocates, community leaders, universities, faith based representatives, business and industry associates and elected officials resulting in a solution that saved lives.  The same approach used in our model can be successfully applied to develop an intelligent and considerate strategy to fairly price specialty drugs while securing the financial markets and expanding research.

The elevated burden of cost of innovative specialty medications is harming patients and interfering with doctors and patients making the best treatment decisions. The outrageously high out of pocket costs for specialty drugs is in desperate need of a CACP model. Recently, Dr. Hagop Kantarjian[1], chair of the Department of Leukemia at MD Anderson Cancer Center and lead author of a recent paper on drug pricing, published in the journal Blood, called for  a ‘dialogue’ in drug pricing with all the various constituents to sit together and decide what to do. So far we have heard that the pharmaceutical companies need to charge the high prices because of their costs to bring these highly sophisticated drugs to market. It is estimated it costs up $1 billion for a biologic/ specialty medication to go through clinical trials, including FDA costs and manufacturing and regulatory fees before it is available to physicians to prescribe.

The Rx in Reach GA campaign  has noticed what is not talked about is the role of the FDA, the insurance industry and the need for patient advocates with community leaders to be present at ‘the table’. The final cost to patients is then also subject to the insurance companies’ discretion as to which formulary tier the drugs get placed. The 4th, 5th and 6th tiers have the highest out of pocket cost to the patient ranging from  hundreds of dollars to thousands of dollars above their insurance co-pay and co-insurance for a one month supply. The enormously high FDA fees for clinical trials in the USA and the free-handed economics of the insurance industry must be addressed. Another critical point left unspoken is the prohibitive cost of these drugs contributes to the widening healthcare disparity. The excessive out of pocket costs will mean only those financially privileged will be able to afford specialty drugs. It screams of the inequity of those who can afford them will get better; those who cannot pay will not and many will die. Our standards of care should be an expression of our humanity and highlight the integrity of our practices.

The cold reality is that serious chronic illness, like cancer, will affect one in three Americans. Chronic illness hits close to home affecting our communities; their health, social and economic well-being. Even with the best insurance, the rate of bankruptcy among people who develop cancer and other serious disease is as much as 30% higher than someone who doesn’t get sick. The new specialty drugs are saving lives and helping people live longer. This is the new path of medicine which brings hope and if sensible and compassionate minds persist, could reduce the long term cost of specialty drugs and health care.

A CACP approach to the high costs of drugs is an inclusive approach where a drug that can 100% cure a disease will be available to 100% of the patients that need it. We must enter the negotiations with the understanding that we are all working together to improve the lives of people who are seriously ill. We must be able to be long-sited realizing the more people reached with the right medication, the more profits will be made while reducing costs to our healthcare system. We must be willing to reject bad economics based on short term profits.  We must be willing to speak up loudly and insist on changing how we do the business of pricing prescription drugs. All stakeholders will benefit when we embrace and agree the financial gain and wellness of our health care is interconnected to the financial, physical and mental wellbeing of the citizens of our communities.

Please take a moment and read about our campaign to help patients at www.rxinreachga.org. Make a decision to join us to break the barriers of healthcare in our state and our nation.