Fact Sheet

Access to Medicines for Chronic Conditions

According to an analysis by Avalere Health, patients in the exchanges that suffer from chronic conditions may face hurdles in accessing needed treatments.

Access to Asthma Medicines in Exchanges

Asthma is a common, chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma, including about 7 million children.

Access to Diabetes Medicines in Exchanges

The annual number of patients who were newly diagnosed with diabetes has tripled in the past twenty years, and type 2 diabetes accounts for 95% of diagnosed diabetes in adults. As many previously uninsured people enroll in exchange coverage and access primary care, the diagnosed cases of diabetes may increase further. Medicines are a key component of managing diabetes. Most patients take oral medicines to stabilize blood sugar levels, but over time, many patients also add insulin to their treatment regimens.

Access to HIV/AIDS Medicines in Exchanges

Prescription medicines are a crucial component of treatment for HIV/AIDS. Multidrug regimens have substantially reduced HIV progression to AIDS, opportunistic infections, hospitalizations, and deaths. Even so, early ART regimens often required patients to ingest several large pills multiple times per day. New formulations, such as single-tablet regimens, reduced the pill burden dramatically, improving adherence and slowing disease progression.

Access to Mental Health Medicines in Exchanges

For many patients with mental health conditions, prescription medicines are a key component of treatment. Antidepressants are highly effective for a range of mental health conditions, with several classes of medicines available. Clinicians generally base selections on highly individualized factors, including the patient’s specific depression symptoms; a prior response to specific antidepressants (if applicable); and side effects. Other common medicines for treating mental health conditions include antipsychotics and bipolar agents.

Access to Multiple Sclerosis Medicines in Exchanges

Multiple sclerosis (MS) is an autoimmune inflammatory disease of the central nervous system that is a leading cause of disability in young adults. MS disrupts the ability of parts of the nervous system to communicate. MS can take several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). Between attacks, symptoms may go away completely; however, permanent neurological problems often occur, especially as the disease advances.

Access to Oncology Medicines in Exchanges

Chemotherapy and other medicines are central to the treatment of nearly all forms of cancer. Chemotherapy has evolved tremendously as researchers have come to better understand the genetic underpinnings of cancer. New, targeted therapies attack aspects of cancer cells that distinguish them from normal, healthy cells and are often designed to treat a handful of specific cancer types. Targeted therapies cause less damage to non-cancer cells; thus these medicines often produce less severe side effects than other kinds of chemotherapy.

Access to Rheumatoid Arthritis Medicines in Exchanges

Rheumatoid Arthritis (RA) is an autoimmune disease that causes chronic joint inflammation and painful swelling that may result in long-term damage and disability. In addition to causing joint problems, RA sometimes can affect other organs of the body—such as the skin, eyes, lungs, and blood vessels. Immunosuppressant medicines are an essential component of RA treatment; these medicines help to reduce inflammation and prevent joint damage.