Insurance Barriers, Bureaucracy Hurt Urology Patients

As patient population grows, providers struggle to provide optimal treatment

WASHINGTON, March 29, 2022 /PRNewswire/ — The nonprofit Alliance for Patient Access today released a white paper that explains how bureaucratic barriers impede personalized care for urological conditions like overactive bladder – and why policy reform is critical. Titled “The Need for Patient-centered Care in American Urology,” the paper is the inaugural publication for the Alliance for Patients Access’ Urology Initiative.


Insurance Coverage Policies Fail Patients and Providers
Insurers’ practices, the paper explains, often prioritize corporate profits over patients’ needs. By delaying or denying treatment access, these policies can harm patients.

  • Imposing step therapy delays patients’ access to newer medications that may be more suitable for their age and condition.
  • Prior authorization ties providers up in lengthy back-and-forth communications over approvals for patients’ medications. This gambles with patients’ progress while also jeopardizing the patient-provider relationship.
  • Limiting co-pay cards’ use or not applying them to patients’ annual deductibles reduces the affordability of medications, especially for older patients, who often face urological conditions and may live on fixed incomes.

Reform Can Facilitate Patient-Centered Care
The paper also highlights avenues for reform.

  • Health plans can ensure adequate payment for telehealth, which helps urology patients stay connected with their providers.
  • Policy reform at the health plan and state level can curb utilization management tactics like prior authorization and step therapy. Commonsense limits will allow providers to treat their patients more quickly and effectively.
  • The Centers for Medicare and Medicaid Services can revise its eligibility rules for covering adult diapers, while the US Pharmacopeia can streamline its classification processes to maximize physicians’ flexibility.

Urological Conditions in the United States

  • One in 11 Americans suffer from kidney stones.
  • About half of all women experience urinary tract infections.
  • Half of all men will experience enlarged prostate by their 50s, with incidence rising with age.
  • 3.1 million men live with prostate cancer, and last year, more than 34,000 died as a result.
  • Overactive bladder, the most prevalent urological condition in the United Statesaffects at least 33 million people.

Established in late 2021, the Alliance for Patient Access’ Urology Initiative is an effort of policy-minded clinicians who treat urological conditions and advocate for patient-centered care.

“Today, tens of millions of Americans suffer from urological disorders. As the US population ages, the number of patients is only expected to grow. New treatments offer patients options for personalized care, but policy barriers and outdated bureaucracy stand in the way. It is imperative policymakers address practices that delay treatment progress, distract providers and undermine the patient-provider relationship.”

READ: “The Need for Patient-centered Care in American Urology”

Tea Alliance for Patient AccessIsa national network of policy-minded health care providers who advocate for patient-centered care and participate in clinician working groups, advocacy initiatives, stakeholder coalitions and the creation of educational materials.

SOURCE Alliance for Patient Access


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