The Daily Rise: Thursday, February 11

Welcome to the Daily Rise.

We know how difficult it can be to track the news that is important and relevant to patients. You’re busy. Your time is limited. That’s why we’re here – to provide you with a regular digest of the stories and news that affects patients.

At Patients Rising, we fight for access to vital therapies and services for patients with life-threatening and chronic diseases. If a patient needs a treatment to survive and live a better quality, more productive life — we believe access to that treatment is essential. Many patients are well taken care of by their insurance plans, but those who do fall through the cracks will remain there as long as reasoned solutions are scarce and we focus more intently on Wall Street and K Street while there are patients living on Main Street who need help today.

We’re working to create a balanced dialogue in the national conversation around these issues. We want to amplify the collective voice of patients to create a lasting impact on the future of heath care in the United States. We will focus on ensuring the patients’ voice is heard, access to new therapies is paramount, and the pipeline of progress is not threatened.

Everything we do is connection. Our goal is to connect other patients, caregivers, physicians, the media, health policy experts and allied healthcare professions — in order to elicit discussions of realistic solutions.

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Investigative Reporter Bill Spencer of Houston’s KPRC has a powerful story of a Houston mother who is being forced to pay triple the price for a life-saving cancer drug after her insurance company denied coverage. “Blue Cross Blue Shield Of Texas, refused to pay for that drug, calling it ‘experimental and investigational’ in their denial letter.”

The kicker: When Ann Marie O’Callaghan tried to pay out of pocket, her hospital, Baylor College of Medicine, tripled the price.

“It’s absolutely outrageous that a woman who has insurance benefits through this plan not be allowed the right to exercise those benefits.” Shawn Fry, CEO of Prevalent, told KPRC. “It’s the whole purpose of why we have insurance.”

You’re Asking The Wrong Question

“How much would you pay to live?”

That’s the headline of a KIRO 7’s investigation into the cost of health care. We can’t help but think patients lose every time this question is asked.

No patient should be forced to decide between their medicine and their life. Great. Can we move on to constructive dialogue about solutions?

In order to make sure patients are getting the right treatment, right now, we need to look at cost issues within each sector: payers, providers, innovators, government regulatory. We also have to engage patients in assessing value. Then, we can find ways to come together for patients to make changes that make regulatory systems cheaper to operate and benefit all bottom lines — especially those of the patient.


This month, we’re joining the millions of patients fighting the devastating policies of insurance companies that enforce “fail first” policies.

Albany’s Times-Union has a great piece (unfortunately, behind a pay wall) that explains why we need to drive a stake through the heart of “fail first,” or what’s known by the more innocuous phrase “step therapy.”

“Individuals are prevented from accessing the medication that their health care provider prescribes until they’ve proven to their insurer that alternative medications they are forced to try don’t work for them,” explains Glenn Liebman, CEO at Mental Health Association of New York State.

A stat to share on Twitter: As of 2012, 54 percent of insurance plans had “fail first” policies for cancer patients. #failfirstfeb

Campaign 2016: To Negotiate or Not Negotiate?

This week’s biggest story is the New Hampshire presidential primary. Bernie Sanders may have trounced Hillary Clinton in the Democratic primary, but The Hill notes that “Clinton is expected to leave New Hampshire with just as many delegates as Bernie Sanders.”

This appears as complicated to figure out as your hospital bill and insurance statements.

Pay no attention to the man behind the curtain.

The majority of the public, both Democrats and Republicans, are in favor of allowing Medicare to negotiate drug prices for medicare beneficiaries. The Kaiser Family Foundation website posted a thoughtful post about this, Searching for Savings in Medicare Drug Price Negotiations.  In closing they note, “the potential to achieve savings from Medicare drug price negotiation depends on details that have yet to be specified by any of the presidential candidates who support the idea. While the future prospects for this proposal and other prescription drug savings proposals may depend on who wins the presidential election in November, which party controls the House and Senate, and whether their policy interests align, the issue of drug price affordability is likely to continue to weigh on the minds of consumers at the pharmacy counter.

You’ll receive updates about new resources, patient stories and insights, advocacy work, and alerts about patient-support events.