Lupus Organizations Advocate for Easier Access to Medication

Ines Martins, PhD avatar

by Ines Martins, PhD |

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The S.L.E. Lupus Foundation is advocating for wider access to medication for patients who suffer from systemic lupus erythematosus (SLE) by signing two Memorandums of Support for Legislative Acts. The non-profit organization, which works as part of the Lupus Agencies of New York State, believes that the memorandums can help patients obtain easier access to treatments prescribed by their physicians which are crucial to fight the chronic inflammatory and autoimmune disease.

The first document, entitled Memorandum of Support for NYS Assembly Act 2834 | Senate Act 3419, intends to end policies of “step therapy” or “first fail,” as well as amend the insurance legislation on the topic. According to the current law, patients need to start with least expensive drug treatments and insurers are only obliged to cover more expensive therapies once those options are excluded or proven ineffective.

“Basing treatment decisions on cost rather than clinical considerations ignores important variations that can exist among patients in terms of safety, efficacy, and tolerability in drug classes. New scientific research shows there are gender, racial, and ethnic differences in responses to treatments, and limiting access will greatly widen already existing health disparities,” states the document. “The determination of the most appropriate medication for a particular individual with multi-system autoimmune diseases or the recipient of an organ donation/transplant must be made on the basis of patient acceptability, prior individual drug response and side-effect profile, and long-term treatment planning — not on cost,” it continues.

The memorandum was signed by 33 different health-related organizations, which defend legislation alterations that can ensure physicians won’t be restricted by these health insurer limitations when prescribing a treatment. According to the S.L.E. Lupus Foundation, making SLE patients wait for so long before receiving coverage for more expensive medications is denying health care that can lead to increased symptoms, more medical complications and higher health care costs.

In addition, the organization has also signed the Memorandum of Support for NYS Assembly Act 6194 | Senate Act 2530, which aims to change the insurance law that determines that patients have to buy their prescription medications at a local in-network pharmacy. The organizations support the Anti-Mandatory Mail Order Drug Requirements and the possibility to receive drugs through mail order.

According to the document, the alterations would remove barriers to medication approval and improve the legislative terms from 2012, eliminate provisions imposing additional requirements regarding community pharmacies, increase rates of medication adherence, as well as protect patient confidentiality, preventing from discrimination and accidental disclosure.

“Individuals with chronic, heterogeneous, complex, multi-system autoimmune diseases such as lupus and other diseases of unmet need require individually tailored treatments. Many of these individuals have multiple co-morbid conditions that require unencumbered access to the full array of treatments,” it states. “Individuals with complex care needs like lupus require unique strategies to manage their care as specific response to any given treatment is not equal.”

The Lupus Foundation of America has also recently advocated for wider access from lupus patients to novel therapies, which they believe are limited by high costs or regulatory restrictions. Therefore, the foundation signed a petition defending the approval of the Patients’ Access to Treatments Act (PATA), which was recently sponsored in the House of Representatives by Lois Capps (D-CA) and David B. McKinley (R-WV) and is thought to meet the need for broad-ranging treatment options for lupus patients.