Aimed Alliance believes:
- Americans must value their health care and prioritize it as consumers.
- Consumers must have access to quality and timely care, customized to their individual needs, and provided in an ethical and transparent manner.
- Innovation leads to cures.
- Patient safety must remain a central priority above all else.
- Patients must have access to and be able to afford treatment most appropriate for their individual needs, including new and innovative treatments, technologies, and clinical trials.
- Health care practitioners should have autonomy over professional discretion; practitioners and patients should make health care decisions, and not third-party payers or pharmacy benefit managers.
- The value of treatment should be measured by the individual patient and not based on cost alone.
- Consumers who purchase health care must not be relegated to overly restrictive networks and inferior quality treatment.
- Health care plans must limit discriminatory benefit utilization management practices, including:
- Burdensome prior authorization processes;
- Clinical pathways in which insurers provide physicians with compensation to prescribe certain treatment, creating a conflict of interest;
- Adverse tiering in which most, if not all, medications used to treat a particular disorder are placed in highest cost specialty tiers;
- Step therapy policies in which patients are forced to try and fail on cheaper, inferior treatments before their prescribed treatment will be covered;
- Non-medical switching in which third-party payers require stable patients to change medications to save money rather than for therapeutic reasons;
- Continuity of care for consumers who change health plans mid-year and who may be required to meet all of the burdens that they had previously met under their prior plan all over again; and
- Lack of oral parity, resulting in more burdensome limitations on coverage of oral medications than on intravenous drugs.
- A one-size-fits-all approach to health care is inappropriate.
- Patients react to treatments differently, so patients must have access to options.
- Health plans and policies must be transparent. Consumers must have clear and meaningful information on coverage limitations and true out-of-pocket costs, so they can make informed decisions about their health care.
- Hospitals should make rates accessible to consumers, including rates for procedures, inpatient and outpatient services, and treatments.
- Third-party payers should not change a plan mid-year.
- Innovative, life-saving medications and treatments that improve the quality of life or reduce human suffering must be accessible to patients.
- Using effective medical treatments can reduce long-term health care costs. Even incremental advances in treatment can provide cost savings.
- The pharmaceutical market is highly competitive. As additional innovative products come to market, the principles of supply and demand will drive prices down. However, lack of access to such medications stifles growth and innovation.
- Patients must feel confident that their medications are authentic and flow through a secure supply chain.
- The decision to substitute one medication for another should be a decision made between the physician and patient, rather than by a third-party payer or pharmacist.
- Risk Evaluation and Mitigation Strategies (REMS) are an efficient method of ensuring that the benefits of a medication with a known risk outweigh those risks.
Aimed Alliance supports:
- Enacting laws and implementing policies that require health care plans, hospitals, and pharmacy benefit managers to maintain adequate levels of quality, safety, ethics, efficiency, and transparency.
- Reducing discriminatory cost-containment practices, such as fail first, adverse tiering (specialty tiers), and burdensome prior authorizations policies.
- Prohibiting third-party payer practices that create a conflict of interest for health care practitioners.
- Allowing health care practitioners and patients to make unbiased, patient-centered medical decisions without interference from third-party payers or pharmacy benefit managers.
- Adopting and covering pharmacogenetic testing, precision medicine, and targeted treatments rather than one-size-fits-all approaches.
- Providing prescribers with the authority to override cost containment policies in an efficient and expedient fashion if they believe a particular treatment is most suitable for their patient.
- Preserving incentives to bring innovative, life-saving therapies to market.
- Developing a coalition of like-minded, patient-focused organizations that aims to improve access to innovative treatments.
- Educating the public and enforcing measures to reduce the illicit market dealing in counterfeit and diverted medications.
- Providing practitioners with discretion to choose when to substitute one treatment for another.
- Preserving programs that reduce the risk of harm to patients, such as REMS.