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Three doctors who have led a task force that evaluates preventive medical services say the group's recommendations shouldn't be tied by law to insurance coverage.

 say the link between medical recommendations and insurance coverage leads to financial incentives that can corrupt the process and distort people's health care decisions.
Under the Affordable Care Act, any preventive service that receives one of the USPSTF's top two ratings 

 by insurance without any out-of-pocket cost for the patient. The doctors advice to decouple the task force ratings from insurance coverage would require a change in the health law.
The authors of 

 point to heavy lobbying by the pharmaceutical company Mylan N.V. to get its anti-allergy device EpiPen deemed a preventive service. They say such lobbying can interfere with the task force's mission to evaluate medical services to improve the health of the overall population.
"When people try to twist that mission for their own purposes, essentially what they're doing is violating the integrity of the task force process, and it's distracting from the mission," says 

, the lead author of the commentary. Moyer, a former chairman of the task force, is now a vice president of the 

The USPSTF is an independent group of volunteer physicians who review the research on preventive medical services, such as vaccines and screenings tests, and recommend who should get them and how often.

 to have the EpiPen listed as a preventive device, even though it is used by people with diagnosed allergies. The 

 is an automatic injector that delivers a dose of epinephrine to stop dangerous allergic reactions. A two-pack costs more than $633, according to 

.
The company has been under fire in recent months because it has raised the price of the device more than fivefold since 2007, even though the product has been on the market for decades. Mylan CEO Heather Bresch has 

 the uproar on trends in insurance coverage that leave patients responsible for a larger share of their medical costs.
If EpiPens were covered as preventive medications, patients could get them at no cost. The price increases Mylan has put in place would be 

 but would have to be borne by insurers.


"What Mylan has done, or what they're attempting to do with this effort, is use a provision in law, which is intended to give people access to preventive services, and use it to their advantage for something that just plain is not a preventive service," Moyer says.

 spurred Moyer and her two colleagues, Dr. Michael LeFevre and Dr. Ned Calonge, who were also task force leaders, to write the opinion piece that questions the overall idea that insurance coverage should be tied by statute to the recommendations of the volunteer medical group.


The authors say the issues with the link go beyond the problem of lobbying. By putting prevention ahead of treatment of illness by making it free of cost, the system created by the ACA may be making treatment of illness more expensive and putting it out of reach of some patients.

"If such financial access comes at the cost of increased deductibles or copays for equally important services that are not preventive, then we must question whether the link inadvertently discourages other important care," they write.

"Perhaps it is time for the USPSTF to inform, but not determine, coverage," they conclude.


A recent survey by the Kaiser Family Foundation shows that 

 of people with insurance through their employer have policies with deductibles of more than $1,000.
Many advocates and economists agree that preventive services 

 but also can improve the quality of health care. When the Affordable Care Act was being debated, advocates on both sides argued whether or not preventive services would save money in the long run.
"Preventive health services have become quite expensive over time," says J

, a resident scholar at the American Enterprise Institute.


He says some preventive services such as vaccines are inexpensive and undoubtedly valuable. Others, such as mammograms, are also medically important but don't necessarily save money.

When those services are provided free, the costs are spread across all policy holders through premiums and deductibles.

But Antos cautions against blaming rising deductibles and premiums only on preventive care.


"To what extent have preventive services been responsible for the big increase in deductibles and co-payments over the last decade or so?" he asks. "I would argue that they've contributed. But we're really talking about 

Business and Economic News

Health

Alison Kodjak

Author

Three former leaders of an influential task force that issues guidelines for preventive care says insurance coverage for highly rated tests and services shouldn't be mandatory.

Rethinking automatic insurance coverage for preventive health care

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