Access to Treatment

My Insurance Company is Not My Doctor

My Insurance Company is Not My Doctor

Learn how the COPD Foundation is working to help patients continue to have access to all medications.

Learn how the COPD Foundation is working to help patients continue to have access to all medications.

Understanding the Current Problem

Recently the COPD Foundation learned of an increasing practice of insurance companies limiting medication choices to control costs. Eliminating access to medications that were previously paid for by insurance companies is becoming a common practice affecting individuals with COPD nationwide.

Many members of our community have come forward to let us know that they have been forced to switch medications despite being well controlled on their current medication regimen and without input from their doctor. Many have experienced negative side effects and diminished quality of life due to these changes. The end result is that patients and physicians may no longer have options when it comes to selecting the most appropriate COPD treatment regimen.

How the System Works

Generally, insurance companies use many tools to help manage the cost of medications and therapies for the beneficiaries (patients) that they cover. To contain costs, many insurance companies use various co-pay structures also known as tiered benefit designs where patients are required to pay more for some medications over others. Another practice, step therapy, requires patients to try one medication and fail on it before switching to another medication. Oftentimes a generic, and therefore less expensive drug, is used first before the insurance company will cover the cost for a more efficacious and more expensive drug. Unfortunately, many of the tools used by insurers to cut costs are not to the benefit of the patient and can directly conflict with physician treatment recommendations.

Why the COPD Foundation is Concerned

There are many ways to manage COPD, there are multiple drugs used to treat COPD and many times multiple attempts must be made at identifying effective treatments. Trying and finding the correct medication combinations for a specific patient requires the physician and patient to have access to all drugs. Limiting a patient’s access to drugs robs the COPD community of the opportunity to benefit from the right drug for the right patient. After all, your insurance company is not your doctor. Only an individual with COPD and their physician can determine what treatment is best, not the insurance provider.

COPD Foundation Stance

The COPD Foundation strongly condemns practices which limit treatment options that are based upon economic considerations and not quality and effectiveness. These practices are against clinical recommendations where patients who have received stable disease control remain on their current medication regimen rather than switching drugs. Studies have showed that switching treatments can create unintended consequences for patients. The COPD Foundation is dedicated to strongly urging all insurers who are considering or have adopted this approach to reconsider. The COPD Foundation strongly supports the rights of patients and the access to all therapies. Our public policy statement and the resolution from our Medical And Scientific Advisory Committee (MASAC) and Clinical Advisory Committee (CAC) Resolution fully state our positions.

What should you do if you or a loved one is denied coverage?

If you are denied coverage you have the right to appeal the decision to your insurance company. New rules in the Affordable Care Act (ACA) specify how your plan must handle your appeal. The COPD Foundation has developed a step-by-step guide to help you navigate the appeals and grievances process.

How do I take action?

Join the COPD Foundation in raising your voice about this alarming new practice. Visit the COPD Action Center to learn how you can send a letter to your federally elected official.

Together we can fight this.

Join Us on COPD360social

Sign In to Participate
Or register to become a member

Download the Access to Treatment Policy Statement


Download the Appeals and Grievances Process


Download the COPD Foundation’s Medical And Scientific Advisory Committee (MASAC) and Clinical Advisory Committee (CAC) Resolution