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Patient Education on Coverage for Biologics and Biosimilars


Amanda Forys, MSPH: When these formulary changes happen, you mentioned some mid-year, some end-of-year, and we’re seeing some legislation kind of pushing for that consistent approach to year-by-year changes. What should be out there for patients to understand that change?

I know for Medicare, for example, on Part D open enrollment, you can go online and go to the plan finder and type in all your drugs and it tells you if your plans are covering it. I know that there are some tools for people buying exchange plans that say those things, but what about me? I’m covered under my husband’s insurance; how does that work for me to get that information, or somebody who’s potentially on a Medicaid plan, or someone who has insurance through another avenue. How are they getting it, what do they need, and how should they be receiving it?

Christy M. Gamble, JD, DrPH, MPH: They’re usually given it (hopefully) through their provider, but some providers don’t have that information. In the oncology space, they’re more likely to have that information.

But, once again, talking about populations that don’t have access, populations of color and low-income populations, that information is not readily accessible to them. They’re not able to know which sites to go to in order to look for this information. It’s really important that when it comes to these types of changes, and what’s covered and what’s not covered, that insurers and manufacturers [and] everyone in the system or the chain should really look at working with organizations that advocate for these patients that can “speak their language,” [and] that know how to reach these populations.

A lot of the information that’s out there is at a high education level, and you really have to be “healthcare savvy,” as I say, to understand what’s going on. If you work with these patient advocacy groups, they’re more likely to be able to put the information [and] synthesize it in a way that the patient population can better understand it.

Amanda Forys, MSPH: How often do you see providers putting in great counseling for patients? Let’s say in oncology practice, usually you see very well-run practices here where they’re seeing huge numbers of patients, they have great office manager staff, not to say that other practices don’t, but oncology is just known for [a] very streamlined care processes. What type of services are they offering, are they good, could you see them enhanced? Do you have any suggestions for improvement for those that you have seen?

Christy M. Gamble, JD, DrPH, MPH: Oncology is a great example of what the other disease states should actually follow. It’s that counseling, it’s that sitting down with patients and going through, because they know the stress level, and they know the anxiety that comes with having that type of diagnosis that patients are willing to do whatever it takes to find the right therapy for them.

They’re sitting down with the patient, they’re sending them referrals to nurses and other support systems, and there are so many oncology patient groups out there to provide that support. So, it’s really working in tandem and working very well with these groups that I hope that the other groups like the [rheumatoid arthritis, RA] groups and lupus groups can actually take heed and follow that model.

We’re seeing that work very well but once again, working with populations that don’t have that access is where we’re seeing a gap. We’re not seeing them reach these people like they should, and coming up with really innovative ways to reach them, because more than likely they’re having a difficult time getting to the providers office, and transportation is a big issue, and getting that support to come out to them.

We’re always pushing for things like telehealth and telemedicine to reach patients where they are, and having that support come to patients. So that’s one thing that we would definitely like to see that gap filled.

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