One of the country’s largest health insurers, Humana, recently made a policy decision that can adversely affect many people with Alpha-1.
Humana now restricts augmentation therapy for Alpha-1 patients to a single product. The critical therapy is available in four formulations that, as biologicals, are not considered generically equivalent.
Humana and other insurance companies make decisions about what they will reimburse, and publish this information for their insurance beneficiaries in what is called a formulary. This decision by Humana indicates to the Alpha-1 Foundation and Alpha-1 Association what may become a serious trend that will adversely affect all who rely on life sustaining infusions.
Below are ways that Alpha-1 patients and members of the Alpha-1 community can help protect and educate themselves and family members:
SHARE YOUR STORY
Alpha-1 patients and their families are encouraged to share their experiences, especially if you have been or are being required to switch augmentation therapy. Were you forced to switch from an augmentation product you were tolerating well to one you never used before? How might it affect your health and care if you were forced to switch? Have you needed to switch augmentation products because of side effects or other issues? If so, email your experiences to ProtectYourTherapy@alpha-1foundation.org.
KNOW THE PROCESS TO ASK FOR CHANGE
If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. You can ask that your insurance company reconsider its decision. Insurers have to tell you why they’ve denied your claim or ended your coverage. And they have to let you know how you can dispute their decisions. If you choose to appeal a coverage denial, there are several strategies that can bolster your case. Click here for the Appeals and Grievances section of the Alpha-1 Association’s Private Health Insurance Toolkit (PHIT). Click here for Humana’s web portal relating to exceptions and appeals.
URGE HUMANA TO REVERSE ITS DECISION TO COVER ONLY ONE AUGMENTATION THERAPY
Humana’s recent formulary policy decision can adversely affect thousands of patients, including many with Alpha-1, as well as more than 3,000 hospitals and nearly 50,000 pharmacies across the country. Its decision implements a formulary limiting alpha-1 antitrypsin augmentation to one product.
It is simple to take action: contact Jack McKnight, Humana’s director of pharmacy clinical strategies, at email@example.com.
Make sure to state:
- You are a patient living with Alpha-1 Antitrypsin Deficiency, a rare, inherited condition that can cause serious and chronic lung disease (or liver) disease.
- There is no cure for Alpha-1 lung disease, but treatments are available.
- Your treatment consists of weekly IV infusions of alpha-1 antitrypsin derived from human plasma.
- You have arrived at the product you currently use because it is best tolerated by you and prescribed by your physician.
- Humana’s recent policy to cover only one augmentation therapy product for Alpha-1-related lung disease may disrupt your current medical treatment and possibly threaten your life.
- Urge Human to reverse its decision to cover only one augmentation therapy product for Alpha-1-related lung disease.
Read complete coverage of the Humana decision, the Foundation’s response and Alpha-1 patient reactions at Don’t Let Insurers Decide.
Full Article & Source:
Patients urged to contact Humana regarding decision to cover only one Alpha-1 therapy