NICA Responds to UnitedHealthcare's Decision to Steer Members to Self-Administered Injectables
Non-profit representing infusion patients and their providers addresses UnitedHealthcare’s recent decision to steer its members to self-administered formulations for reasons unrelated to health or safety.
In comments submitted to UnitedHealthcare (UHC), the National Infusion Center Association (NICA) implored the insurer to rescind its decision to change coverage in a way that would dictate the course of treatment for reasons unrelated to health or safety by denying coverage for provider-administered medications when a self-administered formulation was available.
“Biologics are some of the most innovative and life-changing medications developed in the last decade,” wrote Brian Nyquist, MPH, executive director of NICA. “Consequently, they are some of the most expensive medications. As such, this class of medications brings unique challenges to manufacturers, providers, patients, and insurers, including escalating costs, complex administration, and a volatile reimbursement environment.”
In UHC’s October Medical Policy Update, the organization outlined its plan to switch its members to self-administered formulations for several complex biologic medicines used to treat chronic diseases, including various autoimmune diseases.
Shortly after publishing the October Medical Policy Update, UHC rescinded its decision to impose non-medical switching practices for several medications.
Cost-driven utilization management practices like non-medical switching have received significant scrutiny from health care providers, patients, politicians, and patient advocacy groups like NICA for limiting the providers’ autonomy by dictating the appropriate course of treatment for patients irrespective of their complex conditions.
“Until patients become clinically stable on the right medication, the burdens of disease are undermanaged,” Nyquist wrote. “Switching patients who are clinically stable on a biologic to a different biologic can carry significant financial and quality of life implications.”
In the short period of time since UHC announced its decision to steer members toward self-administered formulations, NICA has heard from healthcare providers across the country who feel that UHC’s decision supersedes their prescribing authority and clinical expertise by dictating the course of treatment for its members, placing patients at unnecessary risk.
Nyquist concluded, “I implore you to rescind this decision and rely on healthcare providers to reduce costs and maximize member value by determining the most appropriate product for their complex patients who are prescribed a therapeutic biological product.”
The National Infusion Center Association (NICA) is a national, nonprofit organization founded to improve patient access to in-office infusion. Since its inception in 2010, NICA has worked to support infusion patients and their office-based care settings through advocacy, education and resource development. NICA is the only organization dedicated to preserving patient access to provider-administered parenteral medications in more economical and accessible alternatives to hospital sites of care.