Compassionate Authorizations and the Role of Health Insurers in the Age of COVID-19

Recently, I have talked with a lot of medically fragile patients who are trying to comply and cooperate with the social distancing recommendations by government officials, but who are finding that their healthcare insurance is not approving payment for an adequate supply of medications.

These folks are not trying to stockpile or hoard, in fact many are simply trying to procure the recommended 90 day supply in order to remain at home and protect more vulnerable Americans from exposure. In some cases, the patient is actually the one trying to get enough so that they can remain in their home because they are vulnerable to a severe or life-threatening output themselves.

The impediment?

Under day-to-day fiscal policy by insurers, approval of more than 90 days is refused. We are not living in a normal day-to-day situation, and the amount of time that we may be required to remain physically distant may be more than 90 days.

A suggestion.

Perhaps allowances of 180 days may be a more reasonable consideration for some medications. Certainly, if the medication has the potential for chronic negative effect, then those clinical considerations come into play, but when the impediment is purely financial, then the policy does not meet the need of the current crisis. In short, it underserves. This suggestion is based on the statements of health experts in response to the Congressional Oversight question about when we can expect a treatment. If the earliest is this summer, then helping promote the Social Distancing measures is critical. When an insurance company policy for payment authorization doesn’t promote, it hinders. If the impediment to an insurer making adjustment is fiscally motivated, then perhaps this is an opportunity for the administration and legislators to enact emergency provisions to relieve that fear.

Where do sick people go?

Generally, sick people go to their provider or more likely, according to consumer data, their pharmacy. It makes sense to think about how illogical the situation of forcing people at risk into communal areas like a pharmacy just to renew a statin, for example, really is.

Of course, if you have to go, consider using the drive through window and be sure and use sanitizing wipes to handle carriers and materials. Pharmacies might consider placing these EPA registered cleansing wipes alongside the drive through windows and pneumatic tube systems in case people forget.

A call for compassionate loosening of fiscal policy.

It will be the little things that loom large in how well we protect ourselves and our fellow men and women during this challenging period. This often includes the quietly heroic acts of facilitating policies and financial support. If it hasn’t been fully considered or implemented, then perhaps now is the proper time for a call to action.

Reprinted with permission

Matthew Minson, MD is a physician and has served as a senior health official at the local, state and federal level. He is the author of a series of books championing individual health and social advocacy published by Texas A&M University press and has been a contributor to C-Span, NPR, and PBS. His website is www.preparetodefendyourself.com