OREGON ACADEMY OF FAMILY PHYSICIANS
CONGRESS OF THE MEMBERS
68th ANNUAL MEETING
April 18, 2015
Resolution #1
Introduced by:
Board of Directors
Subject:
Requiring more information from insurers when denying
medications
WHEREAS every year each insurance company makes changes to their
covered formulary, then sends letters of denial for medications no longer covered
for the new calendar year, and
WHEREAS the letter states only that the medication is no longer covered and
gives no alternative choices of similar medications that are covered by the plan,
and
WHEREAS denial letters are allowed to be vague about the reason for the denial
(“may not be covered because it not on our formulary, may have quantity limits,
or may be unsafe in certain age groups”), and
WHEREAS each letter requires a response and action on the part of the
physician and/or staff in order to continue treating the patient’s medical condition,
and
WHEREAS with a multitude of health plans at each clinic, it is impossible to stay
abreast of each health plan’s covered formulary, and
WHEREAS obtaining a list of covered alternatives currently takes one or two
letters, phone calls, or faxes back and forth with each plan for each denial letter
received, and
WHEREAS the current process wastes valuable staff and physician time, money
and resources that would be better spent caring for patients, and
WHEREAS this denial process denial puts the health of our patients at risk, at
least some of whom will simply stop taking a medicine rather than fight with the
insurance company, and
THEREFORE BE IT RESOLVED that the OAFP will work with the Oregon
Insurance Commission or through the state legislative process to require insurers
to include covered formulary alternatives to each denied medication in the initial
letter of denial of coverage, and
BE IT FURTHER RESOLVED that the OAFP will work with the Oregon Insurance
Commission or through the state legislative process to require that insurers be
proactive, notifying patients and providers before the new formulary takes effect
that a formulary change will affect coverage of a specific medication, and
BE IT FURTHER RESOLVED that the OAFP will work with the Oregon Insurance
Commission or through the state legislative process to require that insurers
provide the specific reason for denial of coverage in the initial letter of denial
(non-formulary, quantity limits exceeded, not safe for age group, etc.)
--------------------------------------------------------------------------------OREGON ACADEMY OF FAMILY PHYSICIANS
CONGRESS OF THE MEMBERS
68th ANNUAL MEETING
April 18, 2015
Resolution #2
Introduced by:
Board of Directors
Subject:
Finding a Solution to the Artificially Inflated Cost of
Pharmaceuticals
WHEREAS family physicians have been advocating for cost savings in medical
care since our inception as a specialty, and
WHEREAS consolidation of pharmaceutical manufacturing and distribution has
resulted in effectively creating a monopoly and is now causing inappropriate
profiteering by drug companies, and
WHEREAS pharmaceutical companies are currently selling previously
affordable generic drugs for extremely inflated prices,
THEREFORE BE IT RESOLVED that the American Academy of Family
Physicians investigate the pharmaceutical industry’s pattern of inappropriate
profiteering from the pharmaceuticals they sell, with the intent of searching
for effective ways of presenting this issue of to the public, to stakeholders, and to
the medical community, and
BE IT FURTHER RESOLVED that the American Academy of Family Physicians
search for ethical, legal and business means to address the pharmaceutical
industry’s pattern of inappropriate profiteering from the pharmaceuticals they
sell.
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OREGON ACADEMY OF FAMILY PHYSICIANS
CONGRESS OF THE MEMBERS
68th ANNUAL MEETING
April 18, 2015
Resolution #3
Introduced by:
Board of Directors
Subject:
Providing education for family physicians to address the social
determinants of health
WHEREAS the social determinants of health are the conditions in which people are
born, grow, live, work and age, and
WHEREAS the social determinants of health are mostly responsible for health
inequities which are the unfair and avoidable differences in health status seen within
communities, and
WHEREAS health inequities exist in Oregon in multiple areas, including rates of
obesity, smoking, and chronic disease, and are stratified by race and socioeconomic
status, and
WHEREAS Oregon residents with low socioeconomic status are nearly twice as likely
to smoke as the state average (1), and
WHEREAS African Americans in Oregon are more than twice as likely to suffer from
diabetes as Non-latino white residents (1), and
WHEREAS in Oregon, Latinos, African Americans, and American Indians/Alaska
Natives have teen pregnancy rates that are 2–3 times higher than non-Latino whites (2),
and
WHEREAS evidence suggests that community based, comprehensive primary care
that integrates health care with other social services can positively impact individual and
community health outcomes.
WHEREAS in providing access to vulnerable populations primary care physicians
reduce health disparities in their communities through such impacts as increasing
vaccination rates, and reducing low birth weight infants, smoking and obesity rates (3).
THEREFORE BE IT RESOLVED that the Oregon Academy of Family Physicians
provide education to its members about the social determinants of health, both what they
are and how family physicians can impact them.
References
1. Oregon Risk Factor Surveillance System, 2005
2. Oregon Health Authority CD Brief: February 12, 2013 Vol. 62, No. 4. Racial and
Ethnic Health Disparities in Oregon
3. Politzer RM, et al. “The Future Role of Health Centers in Improving National
Health.” 2003 Journal of Public Health Policy 24(3/4):296-306.