WASHINGTON, Aug. 13, 2013 /PRNewswire/ -- In a letter to Secretary Kathleen Sebelius, 14 leading patient advocacy groups have called on the Health and Human Services to revisit the Essential Health Benefits regulations issued this year. They assert the current rules will compromise access to medicines for disadvantaged and chronically ill patients.
"All patients, particularly those suffering from complex or debilitating conditions, deserve the best care and most effective medications," said Andrew Sperling, Director of Federal Legislative Advocacy at the National Alliance on Mental Illness. "Currently, the Essential Health Benefits rules do not sufficiently protect patient access to lifesaving medicines."
As written, the EHB rules grant health plans, not prescribing physicians, the authority to decide which medicines patients with life-threatening illnesses can have. Unlike traditional Medicaid, these rules also deprive patients in the expanded Medicaid program many drugs.
The patient groups urge HHS to allow physicians to decide whether certain drugs are necessary and when effective treatment requires off-formulary medications. Further, appeals processes must be transparent and timely. Most importantly, access to medications and specialists must not be discriminatory against patients because of their illnesses.
"The amendments we're advocating for will not only improve patient health outcomes -- they will help reduce overall health care spending," said Joseph Jefferson, Director of Advocacy and Alliance Development at HealthHIV. "Improving adherence to the most effective treatments reduces hospitalizations and generates potential cost savings of approximately $100 billion a year."
"Health plans that disregard individual patient outcomes in favor of short-term cost reductions endanger patients with severe conditions," said Sperling. "But if properly enacted, EHB regulations can guide us toward a reformed healthcare system that ensures quality care and reduces long-term costs."
National Alliance on Mental Illness
NAMI is the nation's largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, support and research and is steadfast in its commitment to raising awareness and building a community of hope.
HealthHIV is one of the nation's largest HIV nonprofits. HealthHIV works toward increased patient access, broader HIV primary care service delivery, and increased attention to fiscal health at every level of the service and program spectrum.
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SOURCE National Alliance on Mental Illness & HealthHIV