EP200: Shenanigans to Deny Coverage for Evidence-Based Treatments, by Stacey Richter

0

Stacey Richter Discusses With Stacey Worthy, Partner at DCBA Law & Policy

Stacey Richter from Relentless Health Value interviewed Stacey Worthy, counsel to Aimed Alliance about copay accumulators, nonmedical switching, and other healthcare topics. Aimed Alliance works to prevent insurer-driven medication switches for stable patients and other policies designed to make it difficult for consumers to access their prescribed treatments. These things happen at the peril of not only the patient, but also the ultimate payer, meaning the employer or taxpayer. It is not uncommon that pharmacy dollars saved are dwarfed by the medical dollars and downstream indirect costs of denying patients medications they need.

Stacey L. Worthy, Esq, is a partner at DCBA Law & Policy, where she counsels members of the health care industry, including nonprofit patient advocacy organizations, treatment programs and providers, recovery residences, urine drug testing laboratories, and pharmaceutical companies. As counsel to the nonprofit Aimed Alliance, Stacey provides legal insights that drive the organization’s education, advocacy, and policy initiatives.

Based on her extensive research and analysis of federal and state laws, regulations, and legislation affecting access to quality health care, Stacey authors scholarly articles for publication, drafts model legislation, develops policy positions, and assists with coalition-building efforts of allied organizations focused on advancing common goals. She is also a featured speaker at national conferences and contributes commentary that addresses important issues impacting patients with serious chronic diseases and rare conditions.

She earned her Juris Doctorate degree from the George Mason University School of Law and graduated magna cum laude from Boston’s Suffolk University.

Podcast Timeline
02:11 Stacey’s role with Patient Power and what Patient Power does.
02:55 A recent Patient Power case study.
05:57 The problematic situation with investigational treatments and the lag between guidelines and science.
06:46 The insurance catch-22 happening for patients.
08:48 The methods of bureaucracy insurance companies will use to avoid paying for expensive treatments.
13:08 The ideal policy in Stacey’s opinion.
15:35 The patient perspective.
17:50 A preview on a study about physician burnout.
19:48 “The big problem there is that health plans are typically siloed.”
20:47 “It’s one pocketbook.”
21:36 Stacey’s advice to employers.
21:49 “You really do need to look at both sides of the plan.”
22:03 Co-payment accumulators.
27:48 The federal stabilization efforts with the Affordable Care Act.
31:14 The problematic switches health systems are doing with drugs that are deemed interchangeable.
34:06 “Those health decisions … should remain with the practitioner.”

Share.

Comments are closed.