Last week, researchers at the University of Missouri found that minorities were twice as likely as white to be diagnosed with colon cancer. Dozens of citizens in majority-black Marion, Alabama, the birthplace of Corretta Scott King, tested positive for tuberculosis recently.
These kinds of stories have become so commonplace that they barely register on the national consciousness. But for the communities they impact, they are all too real.
Chronic illnesses have hit minority communities particularly hard. In today’s America, racial minorities are twice as likely to suffer from chronic illnesses as their white counterparts, across all age and gender groups. From hypertension to obesity to diabetes, the effect of these diseases on minorities, especially African Americans, is crippling, and the costs of long-term treatment are staggering.
Eighty-six percent of all health care spending in 2010 was for people with one or more chronic conditions, according to the Centers for Disease Control. In the past several years, treatments for these conditions have been developed which can dramatically improve the lives of those suffering from chronic illnesses. Getting the right medications into the hands of the patients and providers who need them, however, is proving to be an even greater challenge.
The process to determine insurance coverage for medications is complex, opaque, and widely criticized. Instead of empowering physicians to make their treatment decisions based on what’s needed for the patient to return to good health, narrow formulary lists crafted by insurance companies include or exclude medications as they see fit. As noted recently by Ken McEldowney of Consumer Action, “Narrow, complex formularies are of particular concern to consumers who need specific medications as determined by their doctors. Yet payers can choose not to cover these medications, and insurers tend to make it extremely difficult for consumers to challenge these decisions; in some cases, they even hide the process by which to do so.”
In my more than 35 years as a registered nurse and public health advocate, beginning as the head emergency room nurse at Harlem Hospital in 1979, I’ve always sought to put the health of my patients first. The best treatments improve the health of individuals and communities, and they save money in the long run by preventing readmissions and repeated, unnecessary procedures and prescriptions that treat the symptoms instead of the cause.
The newest generation of prescription drugs holds great promise for the treatment of conditions that disproportionately affect minority patients. The new cholesterol drugs known as PCSK9 inhibitors have great potential for treating the effects of obesity; right now, about four out of five African American women are overweight or obese, according to the Office of Minority Health.
Yet under the current coverage process for prescription drugs, many may never have access to these lifesaving treatments. “Fail first,” an increasingly popular process, requires that patients try cheaper drugs first before moving on to more expensive options, in order to test their effectiveness. This removes the decision making process from the hands of doctors and nurses, subjects patients to drug regimens that may not be what their condition demands.
Stretching out the length of time for patients to run the gauntlet of “fail first” can also allow for their condition to worsen while less-effective treatments are attempted. It’s an incredibly risky, deplorable profit-driven maneuver.
Cost, of course, is the driving factor behind this complex system, yet even that consideration may be overinflated. Payers continue to claim that rising prescription drug costs are crippling their business, but many varieties of discounts exist which reduce the final cost paid by insurers. One study by IMS Health found that “Invoice prices [for medications] increased in 2014, but were offset by off-invoice discounts, rebates and other price concessions.”
All of this comes back to the central focus of health care: to provide patients with the best care possible. At least, that should be the central motivation for pharmaceutical companies, payers, and providers across the industry. Minority communities are already severely restricted in access, which exacerbates the disparities that are rampant in health care in America today. Anti-patient policies have to be a starting point for change.