EPIC Sends Letters to PBMs and Insurers Regarding PERT Coverage


The Exocrine Pancreatic Insufficiency Coalition (EPIC), a coalition of likeminded organizations convened by Aimed Alliance to advocate on behalf of patients with Exocrine Pancreatic Insufficiency (EPI), sent thank you letters to insurers and pharmacy benefit managers (PBMs) last week. EPI is a condition that occurs when the human body is unable to provide an adequate supply of digestive enzymes and commonly occurs in individuals with cystic fibrosis and chronic pancreatitis. Patients with this condition are unable to properly digest food, which causes gastrointestinal upset and difficulty absorbing nutrients from the food that they eat.

These letters expressed the Coalition’s gratitude for these insurers and pharmacy benefit managers, which elected to continue covering pancreatic enzyme replacement therapies (PERTs) for patients with EPI.

Letters of gratitude were sent to:

In addition to these letters, EPIC also sent a letter to CVS Health, inquiring about the coverage status of PERT products. CVS Health appears to have dropped coverage of certain PERT products after the plan year has begun, which could result in nonmedical switching for stable patients. This is a concern because without access to these therapies, patients can experience digestive complications that could lower their quality of life and place their health at risk. EPIC will continue to monitor this situation.


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