34 THE COURIER SUN • FEBRUARY 16, 2017 FOR BREAKING NEWS VISIT www.qns.com wellness Knowing your options if you are denied the cardiovascular medicine you need As we approach American Heart Month, one important topic must be addressed: improving access to innovative therapies for patients suffering from cardiovascular disease (CVD). When prescribed a medication by a physician, most individuals expect to receive the medication without jumping through hurdles. However, for many people affected by cardiovascular disease across the country, this is increasingly not always the case. According to Symphony Health Solutions, commercial payers deny up to 90 percent of initial claims submissions for patients with CVD, with the final rejection rate for patients at 73 percent. Many of these patients who are rejected have high cholesterol and/or familial hypercholesterolemia (FH), which is an inherited form of significantly high cholesterol and one of the most common genetic diseases, affecting at least one in every 200 to 500 people. Thus, these patients are exploring new treatment regimens because they have not been able to get their low-density lipoprotein cholesterol (LDL-C), or "bad" cholesterol, under control despite treatment with a statin - the current standard of treatment. Additionally, many patients living with atherosclerotic cardiovascular disease (ASCVD), which is caused by a build-up of cholesterol-rich plaque in the arteries, are unable to get their LDL-C under control with current treatment options. With CVD being a major public health concern in the U.S, it is imperative to lower bad cholesterol for patients who have already had a cardiovascular event, like a heart attack or stroke, as well as patients with FH who require additional treatment options to lower their LDL-C levels along with their statin. Yet, there is a growing concern that many patients with uncontrolled LDL-C levels continue to face challenges in accessing PCSK9 inhibitors their physicians have prescribed based on the approved indication. PCSK9 (or proprotein convertase subtilisin/kexin type 9) inhibitors are human monoclonal antibodies that block the protein PCKS9, which prevents the body's natural system from eliminating "bad" cholesterol (low-density lipoprotein cholesterol or LDL-C) from the blood. While the U.S. Food and Drug Administration carefully determined which patients would be appropriate for PCSK9 therapy given the clinical trial information, many payers have implemented restrictive prior authorization processes using stringent utilization management criteria, which is resulting in many patients being denied access. This is not unique to PCSK9s though; we have seen these restrictive authorization practices affecting patients seeking hepatitis C and heart failure treatments as well. Being denied access to the medicine you are prescribed is tremendously frustrating and can leave patients feeling hopeless. However, it is important to know that, as a patient, there are certain things you can do to take action if this happens to you: • Talk to your doctor. If you are denied access to vital treatment, talk with your physician about what you can do to receive the therapy you need. • Share your story. Patients and physicians should feel empowered to speak out and engage with their networks, sharing their stories to help drive attention and awareness to the issue. • Engage advocates. Seek out advocacy groups and patient networks that have resources. Now is an opportune time for patients to be aware of the options available, especially when they are denied access to treatments prescribed by their physicians. In keeping with the spirit of American Heart Month, make wellness a priority. If you or a loved one suffers from CVD, talk with your physician to ensure you are receiving the appropriate medical care. For more information, please visit www.advancecardiohealth.org. Courtesy BPT Longer battery life gives patient with heart condition a new outlook on life By the time Emily H. turned 27, she had received her third life-saving heart device. While she was happy to be alive, she couldn't help but question why the implantable cardioverter defibrillator (ICD) surgically inserted in her chest needed to be replaced with such frequency. At this rate, she would undergo three more surgeries and pay nearly $30,000 in out-of-pocket medical bills before she reached her 35th birthday. "I found out I had a hereditary heart condition just before entering my sophomore year of college," she recalled. "I knew my life would never be the same after receiving my diagnosis, but I couldn't have imagined the physical, emotional and financial toll that my dependency on a cardiac device would have on me and those who love me." Emily was diagnosed with hypertrophic cardiomyopathy, or a thickened heart muscle, at the age of 19. The condition makes it more difficult for the heart to pump blood and could eventually cause sudden cardiac arrest. In order to prevent sudden death, Emily's doctor implanted an ICD to continuously monitor her heart rhythm and deliver a life-saving shock, if necessary. Her first device battery lasted just five years. It was at that point Emily faced the reality that the batteries that power ICD devices do not last indefinitely. When her second device had to be replaced after only two years, she began to worry, wondering how many more devices she would need and how much money she would have to save for the next inevitable, yet unpredictable, replacement procedure. "With my condition, my savings account isn't just dedicated for unexpected home repairs, a winter vacation or my children's college funds," Emily said. "I have to always be ready for future device replacement surgeries, and the weight of the financial burden that accompanies those surgeries is huge." Emily talked with her doctor when she was due for her third device and learned that medical device companies have been working to advance technology to extend the life of ICD batteries and lessen the burden on patients who need them. Now, at age 33, Emily has a Boston Scientific ICD that her doctor expects will last up to 11 years - nearly three times as long as the four-year average of her previous devices. "I'm so grateful for the improved battery technology that Boston Scientific offers because it's truly impacting not just my life, but the lives of my husband and two small children," Emily said. "I am optimistic about my future and glad my doctors have access to this device that gives me and my family peace of mind." Potential questions to ask your doctor about ICD's: • What device options do I have available to me and how do they differ from each other? • How long will the device battery last and how soon should I expect to undergo a replacement procedure? • What resources can I review to gather additional information about the procedure and/or recommended device? Courtesy BPT Emily H. enjoying the outdoors with her husband and two children.
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