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My view: Utahns want health plans to disclose why they won't cover doctor-prescribed treatments

Is it any wonder that an overwhelming majority of Utahns (89 percent) say it's somewhat or very important for health plans to disclose how often and why they decide to deny coverage of doctor-prescribed treatments?
Is it any wonder that an overwhelming majority of Utahns (89 percent) say it's somewhat or very important for health plans to disclose how often and why they decide to deny coverage of doctor-prescribed treatments?
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A recent nationwide study by the Partnership to Fight Chronic Disease (PFCD) found that 33 percent of Utahns say their health insurance coverage is getting worse and 46 percent have seen their costs increase. Overall, Utahns say their top health care priorities for politicians and government officials should be managing premium increases, lowering co-pays and deductibles and holding insurance companies accountable.

While this data might sound depressingly familiar, a closer look reveals something even more troubling, and it’s about more than just money. Emerging before our eyes is a practice causing real harm to patients — the denial of critical medicines by health insurers. Utahns are paying their premiums, but when a medical necessity arises, their insurers are increasingly saying no.

The poll backs this up, as 21 percent of Utahns said the treatment their doctor recommended was not covered by insurance and 23 percent said the treatment of someone they know was not covered.

Think about that for a moment. One in five and almost one in four might not be a big number in a head-to-head political election — but as a population of patients denied treatments their doctor prescribes? It’s nothing short of astronomical.

Is it any wonder that an overwhelming majority of Utahns (89 percent) say it’s somewhat or very important for health plans to disclose how often and why they decide to deny coverage of doctor-prescribed treatments?

The real tragedy here is that this has effectively turned patients into expenditures on a spreadsheet and shrouded by the fact that many patients will inevitably forgo the fight for the medications prescribed by their doctor and submit to insurer decision in favor of less-expensive and even less-effective options.

If a patient is in the position to fight, argue and remain adamant in the face of insurer denials, they may eventually obtain access to what their doctors recommend. Unfortunately, many patients accept these decisions; already fighting for their lives, they don’t need one more enemy to combat.

Advocates and patients must stand up for their rights and lawmakers and regulators must listen and develop realistic solutions. Providers should not capitulate to insurer pressure by prescribing cheaper medications, and should instead facilitate the therapies they believe are best for their patients and offer reforms to make this system work.

Insurers cannot operate under the belief that a patient must fail first on lower-cost medications before agreeing to provide therapies doctors prescribe. Like everyone else, insurers should be held accountable for these decisions and must act with transparency.

While much of the country debates drug prices, we are unwise to ignore the real harm that patients in Utah say they are experiencing in the form of barriers to medical access and just chalk it up to one more intractable health care policy fight.

This problem isn’t going away, and it will be waiting for the next president in 2017. When Donald Trump takes the oath of office in 2017, ask yourself this: We require doctors to take an oath to do no harm; should insurers do the same?

Jonathan Wilcox is co-founder and policy director for Patients Rising and Patients Rising NOW.