A study endeavored to assess insurance coverage and switching across payers among people with severe Hemophilia A. The results were published as a poster at AMCP Nexus 2021.
“Gene therapies and other anticipated breakthrough treatments hold potential to substantially offset chronic, traditional factor VIII prophylaxis in specific populations. However, fragmentation of the US insurance system may impact payer approaches to coverage of new treatments given concerns about insurance ‘switching’ by patients and the ability to realize cost offsets over time,” the researchers wrote.
Researchers assessed a cohort of 3,677 patients who were identified in the ATHNdataset between Jan. 2018 and Sept. 2019. In the population of interest, approximately 52% had commercial primary insurance followed by Medicare coverage (29%). The study outcomes were defined as distribution of current primary insurance coverage by category, mean years of coverage per payer for commercially insured patients including those with at least two commercial payers, as well as for those who switched insurance categories (e.g., coverage by a commercial payer and government payer). The mean length of follow-up in the database was 6.3 years for patients with at least one year of follow-up.
Among patients who were ever commercially insured, almost about 75% had the same commercial payer for the entire follow-up period. The mean time covered by the same commercial insurance was 4.8 years. The analysis showed that only 7.5% of patients switched insurance categories (e.g., from commercial to Medicaid). Among those who switched categories, the researchers observed that patients averaged 3.9 years of commercial coverage, 4.0 years of Medicaid coverage, and 4.8 years of Medicare coverage during the follow-up period.
“Both commercially- and government-insured patients with severe Hemophilia A typically maintain continuous coverage for extended periods, with limited switching between payers and insurance categories over time,” the researchers concluded. “These findings suggest that should breakthrough treatments be approved payers would likely be able to realize potential cost offsets within the first four to five years post-treatment.”
Source: He C, et al. Health Insurance Coverage and Switching Among People with Hemophilia a In the United States. Poster D7. Published for AMCP Nexus 2021; Oct. 18-21, 2021, Denver, CO.