Patient Advocates Target Drug Access Barriers

Advocates at the BIO Patient Advocacy Changemakers Event highlight how utilization management limits patient treatment access.

Updated on Oct. 22, 2026 in Healthcare

Isometric editorial illustration of a glass medicine vial surrounded by layered geometric blocks, representing systemic barriers to pharmaceutical access. — Patient advocates recently challenged industry policies at the BIO Patient Advocacy Changemakers Event, citing utilization management as a barrier to medication access. AI Illustration. Upload story photo >

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Patient advocates recently gathered in Washington, DC, to challenge industry policies that restrict access to pharmaceutical treatments. They argue that utilization management tools and copay accumulator policies create significant hurdles for patients needing essential medications.

Why it matters

Advocates contend that current insurance coverage and cost policies are failing to keep pace with rapid biopharmaceutical innovation. They emphasize the need for systemic changes to ensure that existing medical treatments are accessible to those who need them most.

Approximately 80 percent of psoriasis patients and 90 percent of Medicare patients report experiencing utilization management. Insurers and pharmacy benefit managers currently redirect $7 billion of copay assistance through accumulator and maximizer policies.

The players

National Psoriasis Foundation

This non-profit organization represents individuals living with psoriasis and psoriatic arthritis and actively negotiates for better healthcare coverage.

HIV+Hepatitis Policy Institute

This organization advocates for policy improvements for individuals living with HIV and hepatitis, including legal actions against discriminatory insurance practices.

The details

Insurers frequently apply prior authorization and step therapy requirements, which can delay or prevent access to prescribed medications. In one instance, a health insurer initially required patients to try 14 therapies over 42 months before approving a specific psoriasis treatment, a mandate later reduced to five therapies over 15 months following negotiations.

Three years ago, the HIV+Hepatitis Policy Institute filed a discrimination lawsuit regarding HIV drug coverage.
Earlier in 2026, a health insurer released a restrictive policy regarding access to a psoriasis treatment.
October 22, 2026, was the date of the BIO Patient Advocacy Changemakers Event in Washington, DC.

Market Landscape

The ongoing struggle between patient advocacy groups and health insurers reflects the broader tension within the U.S. healthcare system regarding pharmaceutical costs. These efforts follow a pattern set by legal challenges to the Affordable Care Act's nondiscrimination provisions.

Patients may face significant administrative hurdles, such as prior authorization or step therapy, when attempting to fill prescriptions. These policies can lead to higher out-of-pocket costs if patient assistance funds are redirected by insurance providers.

The takeaway

Patients should verify their insurance coverage details and step therapy requirements before starting new, high-cost medications. Keeping detailed records of denied access attempts can support advocacy efforts when negotiating with insurance providers or pharmacy benefit managers.