By: ARIEL J. WARDEN-JARRETT, MD, FAAFP

Physicians, legislators, insurance company leaders and the general public may have different educational or socioeconomic backgrounds and legislative agendas, but at the end of the day, we share a common denominator: WE ARE ALL PATIENTS.

As we embark on a new election year, know your value. Our country may be divided politically, but that should not stop us from aiming to unify, especially on healthcare issues.

Here are some key strategies for you to engage in health advocacy:

1. Identify your top health issues that align with your personal core value system.
2. Educate yourself on the subject matter from trusted resources instead of falling prey to the propaganda of click bait as a source.
3. Meet with your legislators. Share your stories and experiences, so lawmakers can make decisions with YOU in mind.
4. Exercise your right to vote, and encourage your network of family and friends to do the same.

Have you reached out to your legislators? Believe me, they want to hear from you! Each of us adds value to the pool of wisdom, but only if we share our stories in settings that have power to influence change.

2024 is not the year to be a diminished chord waiting for the resolve. Rather, come out of the gate to form a united major chord. Be the change you wish to see! Know your value and stand strong!

By: Ariel J. Warden-Jarrett, MD, FAAFP

“Doc, you really have to help me lose weight!”

Your doctor smiles at you and states, “Sure, let’s go over your options.”

You ask about Semaglutide because you saw TikTok video, and you have a colleague that lost 50 pounds on the injections. After an in-depth discussion, you and your provider agree to try Wegovy® (Semaglutide). You are so excited! But the excitement is short lived. When you go to pick up your prescription, you learn from the pharmacist the following:

1. Your insurance won’t cover it and it will cost you $1,200 per month out of pocket.
2. There is a back order as the demand has exceeded the supply.

You feel helpless, defeated and lost all over again. What do you do?

It is important to understand that your employer selects your benefits, but the insurance company also selects the medication formulary. They indirectly work together. Therefore, you cannot assume that individuals with the same insurance plan that work for different companies will have the same coverage.

1. If the medication is not covered on the insurance formulary or by the employer, check to see what needs to be done to see if you qualify for an “exception.” This process is often called a prior authorization. In this case, the treating provider appeals to the insurance company to cover the requested medication due to a specific medical necessity. Unfortunately, the process can take time, and with many medical offices experiencing staffing shortages, the process can take even longer.
2. Next, reach out directly to the pharmaceutical company to see if they have programs/coupons that you may qualify for in order to bring your out-of-pocket costs down.
3. Reach out to your employer to see if there are plans to cover weight loss medications. Maybe you are not the only one needing the medication. Perhaps if enough employees reach out, the employer may recognize the potential need and include the option during the next open enrollment.
4. Last but not least, reach out to your elected official and share your frustrations with trying to obtain access to medication that your provider prescribed. They may be able to use their influence to urge pharmaceutical companies to increase their production of certain medication based on the demand.

I have had several patients that went through steps 1 and 2. We were able to get the medication approved through a prior authorization. Each circumstance is different, but together we can work to help you reach a more desirable health outcome.

By: Ariel J. Warden-Jarrett, MD, FAAFP

Healthcare policy seems like a game of hide and seek. This is frustrating to patients and providers, as it seems like the game is rigged for the insurance company to always win. Patient advocacy helps to level the playing ground and happens to be one of my passions. As the current president of the Maryland Academy of Family Physicians, I continue to realize that for the state of our healthcare system to improve, we need people dedicated to framing the narratives of healthcare policy.

Get Ready

Advocacy experience has taught me that our legislators are moved by hearing the “stories” of their constituents. For example, If you feel passionate that medication costs are rising out of control and hindering your health, your legislative representatives should know about it. I once heard of a story where the legislator actually reached out to the drug company for a patient, and the cost was reduced to an affordable rate for the patient.

Get Set

At Maryland Primary Care Physicians, we have providers who take time to reach out to both state and federal legislators. But to be more effective, it helps if the providers and patients work collectively to advance the needle of healthcare progress.

The first step is to find out who your representatives are, then reach out. If your care was delayed because of a prior authorization, they should know, as this practice potentially hurts both providers and patients.

Learn to speak out! There are websites and smart phone applications that make it easy for you. Reach out on topics that you are passionate about.

Go!

This resource is a great place to start. You enter your address/zip code, and your state and federal legislators are listed. Clicking on their profiles gives you their contact information. Tell your stories! Let’s push the needle forward.

It’s time to inform the legislators who make decisions about your healthcare about how their policies are impacting you. Most of them do not have degrees in healthcare, yet their influence to vote on policies framing healthcare is powerful. They won’t know unless we reach out.

Keep reading your newsletter and emails. Share your stories, and together we can ignite to become a force of positive impact for our healthcare system.

Get Ready. Get Set. Go!

While COVID-19 remains active in our communities and personal lives, improved community and transmission rates allow for a modification of our Masking Guidelines.

Wearing a mask will be optional within our waiting and patient care areas provided that the community-established transmission rate is reported low or moderate.

Individuals that have active respiratory symptoms such as coughing, congestion or sneezing will be required to wear a mask.

We encourage individuals with higher COVID-19 risk, such as immunosuppressed individuals and patients over 65, to wear a mask.

Staff and providers will wear a mask when clinically appropriate, when interacting with high-risk individuals, or to accommodate patients choosing to wear a mask.

We encourage the use of a well-fitting, high-quality mask such as N95 or KN95 masks.

We will continue to follow the latest guidance from the CDC and the Maryland Department of Health to adjust our policies and practices as changes occur in community transmission levels.