As a result of the COVID-19 pandemic, patients with autoimmune
disorders who depend on caregiver-administered drugs face serious challenges to
their safety, according to a recent analysis published by Avalere Health. Many
patients who need to visit a clinical site to receive treatment for autoimmune
disorders are confronted with a difficult choice: go out in public to face the
danger of a virulent, fast-spreading pandemic for which they are at acute risk,
or stay home and go without their medication.
"[Immunocompromised] patients are experiencing this maybe
more acutely than any of us," says Lance Grady, a managing director at
Avalere and one of the authors of the white paper.
Grady points out that some workaround treatments for autoimmune
conditions are possible, but for the most part they would require a clinical
visit for physical tests in addition to a telehealth consultation. Home care
does offer fewer patient safety drawbacks than an on-site visit to a clinic or
hospital, but for Medicare patients, that would require shifting medicines that
are usually covered under Part B to Part D.
Home care may also be too expensive for or just plain
unavailable to many patients, says Joe Paduda, founder and principal of Health
Strategy Associates.
Given these challenges in administering care, some patients have
simply not been able to get their treatment. According to the Avalere analysis,
"early data following the COVID outbreak shows a reduction in physician
office visits, driving a decrease in provider- administered drug
utilization."
Both the Avalere analysis and Paduda point out that costs to
payers and patients could increase due to the expected shift in care sites for
patients with autoimmune disorders.
Paduda says he expects immunodeficient patients, particularly
those covered by MA and Part D plans, to bear higher out-of-pocket costs for
their treatment. He adds that PBMs, too, will likely bear a higher cost burden
in the autoimmune category. "PBMs almost certainly did not factor this
shift into their pricing for 2020, an eventuality no one could have
anticipated. Margins will deteriorate," he says.
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