This issue brief explores current prior authorization policies for sickle cell disease therapies under state fee-for-service Medicaid programs to highlight variations across states and identify opportunities to build consistency and transparency in establishing policies for prior authorization.
This paper is co-created by IVI and Sick Cells in pursuit of a shared goal to advance racial and health equity in and through the practice of HTA in the U.S. In the United States, the healthcare system is vast and involves many actors. This paper focuses on how racism can influence health technology assessments (HTAs) and determination of “value” when assessing new treatments.
In April 2022, Sick Cells conducted a survey of decision-makers at state Medicaid programs. Survey findings were supplemented with an environmental scan to illuminate the state of access to SCD therapies in Medicaid—where there are challenges today and how access to therapies could be improved.
Sick Cells developed and fielded an online survey to gather U.S. patient and caregiver work and activity impairment, and out of pocket costs to include in the ICER review of the medications as contextual information. Analyses included 452 respondents, representing 287 patients and 165 caregivers. Results were presented at the 2020 National SCDAA Convention on October 14, 2020.
Sick Cells worked with Partnership to Improve Patient Care (PIPC), National Minority Quality Forum (MNQF) and Axis Advocacy to compose a white paper looking at the current methods of cost-effectiveness analysis. This white paper examines ways that current methods fail to reflect true value to patients and will offer recommendations regarding methods to address this inequity.
Sick Cells partnered with the Caregiver Action Network (CAN) to strengthen their Caregiver Help Desk to serve the sickle cell disease (SCD) community. This report explains our findings and outputs from this work.
El 18 de agosto del 2021, Sick Cells fue anfitrión de una discusión de mesa redonda con individuos de la comunidad Hispana quienes viven con la enfermedad de células falciformes (ECF) o quienes cuidan por familiares con ECF. El enfoque de la discusión era de identificar brechas educativas claves, crear herramientas educativas dirigidas para llenar estas brechas, e informar nuestras recomendaciones para los grupos interesados. Este reporte es un resumen de nuestros hallazgos.
On August 18th, 2021, Sick Cells hosted a multi-stakeholder roundtable discussion with individuals from the Hispanic community who live with SCD or care for loved ones with SCD. The goal of the roundtable was to understand SCD within the Hispanic community, identify key educational gaps, and create targeted educational tools to fill those gaps. This report is a summary of our findings.
Sick Cells and Avalere Health partnered to host a multi-stakeholder dialogue to discuss and identify barriers to accessing quality care. Through this dialogue, we have developed a strategic roadmap to advance the care and lives of people living with sickle cell.
Since 2019, Sick Cells has worked to highlight the patient voice in coverage decision meetings by training advocates to share their story. To date, Sick Cells has trained over 25 individuals to advocate for sickle cell disease coverage in their state. This paper outlines the process Sick Cells follows to ensure the patient voice is reflected and prioritized in Medicaid coverage decisions across the country, and reviews current barriers and potential solutions to improve stakeholder engagement at these Drug Utilization Review Board (DURB) and Pharmacy & Therapeutics (P&T) committee meetings.
Sick Cells hosted a first-of-its-kind multi-stakeholder summit to discuss the changing landscape of healthcare coverage for sickle cell disease (SCD), called The Coverage for SCD Summit. This report contains proceedings and recommendations from this summit, which are intended to inform next steps to drive collaborative efforts and address gaps in access and coverage for SCD treatments.