Alabama has the second highest death rate from cardiovascular disease in the country yet state health plans reject more than 50 percent of claims for treatment
WASHINGTON – On Friday, June 23, the Partnership to Advance Cardiovascular Health, along with Mended Hearts, will host “The Status of Cardiovascular Health in Alabama: A Forum.” The lunchtime event in Birmingham will bring together patient advocates, clinicians and policymakers to discuss innovations in cardiovascular therapies, high rates of cardiovascular disease in Alabama and barriers that patients face in accessing new cholesterol-lowering drugs. In an Alabama Health Plan Coverage Report Card from the Institute for Patient Access, data shows Alabama health plans reject more than 50 percent of claims for PCSK9 inhibitors.
The Alabama Department of Health, along with Mended Hearts, the largest patient-to-patient heart health advocacy organization in the country, and Birmingham cardiologists will participate in the forum.
PCSK9 inhibitors work by extending the lifespan of a receptor on the liver that clears LDL, or “bad” cholesterol. Patients, some with a genetic condition called familial hypercholesterolemia, or FH, are at increased risk for cardiac events such as heart attack and stroke because of extremely high levels of LDL. Clinical trials data show that PCSK9 inhibitors can lower LDL cholesterol more than statins alone and can also reduce the associated risks of heart attack and stroke.
The Alabama Health Plan Coverage Report Card data, collected from August 2015 to July 2016 by a national data supplier, reflects PCSK9 inhibitor claims for Alabama managed care organizations, including commercial plans, Medicare and managed Medicaid.
Key Alabama Findings:
- 53% average rejection rate
- 976 total rejections
- 238 appeals
- Highest rates of rejection: Federal Employee Benefit Plan (87%), BCBS AL (60%), Express Scripts (59%), Cigna Healthcare (59%)
- Lowest rates of rejection: CVS Health (51%), Tricare Military Health SVC SYS (47%), United Health Group (46%), Humana Health Plan (28%)
The least patient-friendly plans were the Federal Employee Benefit Plan, with a rejection rate of 87%, and BCBS AL at 60%. Also denying claims at a higher rate than the state average were Express Scripts, 59%, and Cigna Healthcare, 59%. Humana Health Plan had the lowest rejection rate, though it still denied almost a third of claims.
In conjunction with the forum, the Partnership to Advance Cardiovascular Health this week will launch a national change.orgpetition to the National Association of Insurance Commissioners to raise awareness about the alarming rejection rates that qualifying patients face in Alabama and across the country.
Friday, June 23
11:00am
The American Heart Association
1449 Medical Park Drive S.
Birmingham, AL
The event is open to the press. Press interested in attending should RSVP to Susan Hepworth at shepworth@allianceforpatientaccess.org no later than Thursday, June 22.
Resources
Partnership to Advance Cardiovascular Health http://www.advancecardiohealth.org