The Alpha-1 Foundation and Alpha-1 Association are urging health insurer Humana to reverse its “bad policy decision” to cover only one augmentation therapy product for Alpha-1-related lung disease.
Humana is one of the largest health insurers in the United States. Its formulary policy decisions can adversely affect many thousands of patients, including many with Alpha-1, as well as more than 3,000 hospitals and nearly 50,000 pharmacies across the country.
“On behalf of individuals and their family members who suffer from Alpha-1 Antitrypsin Deficiency, commonly known as Alpha-1, we write to alert you to a bad policy decision in your 2014 Prescription Drug Guide,” said John Walsh, Foundation president and CEO, in a letter to Humana. “The Alpha-1 Foundation and Alpha-1 Association strongly oppose Humana’s decision to implement a strict, single agent formulary for alpha-1 antitrypsin augmentation, a critical therapeutic available in four formulations that, as biologicals, are not considered generically equivalent. Our opposition is based on medical practice, patient tolerance and scientific literature which indicates that products for the augmentation of Alpha-1 Antitrypsin Deficiency are not clinically equivalent or interchangeable. Instituting a single source formulary will endanger your beneficiaries who have Alpha-1 Antitrypsin Deficiency and require this life-saving and medically effective treatment.”
Walsh’s letter includes a resolution from the Foundation’s Medical and Scientific Advisory Committee (MASAC) that contradicts Humana’s explanation for the decision.
“This Humana policy will prevent physicians from choosing the therapy that is most appropriate for their patient’s medical condition and provides access to alternate therapies only after an allergic or adverse event has occurred,” the Walsh letter points out. “This policy ignores both patient and product variability and requires that a patient be harmed before a physician may select the product they believe is most medically appropriate for the patient. In addition, your policy risks the care of a currently stabilized patient on a therapy and disrupts their treatment unnecessarily by requiring all patients with Alpha-1 to switch to the current Humana preferred product.”
The MASAC letter, signed by Robert Sandhaus, MD, PhD, says it is “unacceptable to limit availability of augmentation therapy in any way and especially to a single product, or require that individuals provide documentation of failure or adverse experience with a particular product in order to receive or continue receiving their drug of choice.”
The Alpha-1 Foundation and the Alpha-1 Association invite Alpha-1 patients and their families to share their experiences with being required to switch their augmentation therapy.
Were you forced to switch from an augmentation product you were tolerating well to one you never used before? How might it affect your health and care if you were forced to switch? Have you needed to switch augmentation products because of side effects or other issues?
Please send your experiences to ProtectYourTherapy@alpha-1foundation.org.
Read the complete letter from John Walsh to Humana and the MASAC resolution here.
Read Humana’s response here.