Commentary: Veterans among most at risk during virus outbreak

By Ray Miller / For The Herald

As communities all over Washington confront the coronavirus threat, there’s been an intensified conversation around safeguarding our most vulnerable patient populations; specifically the elderly and those with compromised immune systems.

As the chief executive of Vets Place Northwest, an organization that works to protect veterans in Washington state, I know that special emphasis must be placed on the needs of veterans and their families during this uncertain time. Specifically, we must ensure that vets have access to the medicines and care they need to stay healthy now and in the future.

After departing the service, our nation’s veterans are more at risk for chronic illnesses, such as diabetes that lead to compromised immune systems. They’re also more likely to be homeless than the population at large, a compounding factor when we think about population vulnerability during a pandemic.

With the aid of additional emergency powers, local, state and federal leaders are working to enhance response capacity in our communities. This is an important first step, and we should applaud Washington leaders for setting an example for the nation on how to try and beat the infection curve through social-distancing measures that reduce new exposures and can limit the spread of the illness.

Once the first wave response subsides and we are able to deploy a vaccine, our communities will shift from surveillance and immediate response to therapeutic intervention.

Over the last century, vaccine development and availability has reduced incidence and mortality for a range of viruses including polio, smallpox, mumps, tetanus, measles and Hepatitis B. In each instance, it takes a collaborative public-private partnership to realize the benefits. The same will be true for Covid-19.

In the current situation, 60 companies across the world are working to thread the needle of medical discovery; finding a therapeutic response to a novel virus that’s both efficacious and safe across a wide range of clinical trial participants.

This process is as expensive as it is time-consuming; recent national estimates indicate a vaccine could cost hundreds of millions of dollars in investment and thousands of hours clocked by scientists working hard to develop and test a viable therapy suitable for mass consumption. And it will require close collaboration between government health agencies and the private sector to get this right.

As Americans anxiously await the development of a coronavirus vaccine, they now share an urgent thread of concern with patients across the country who have been waiting for new therapeutics as yet undiscovered for a variety of illnesses.

While Congress does the important work of passing emergency response packages, there are other actions they could consider over the longer term that could help speed new medical innovation to help vulnerable patients, like veterans, afford their medicines at the pharmacy counter.

Veterans often enroll in Medicare to supplement their Veterans Administration benefits, but like many Americans, they face increased costs through rising co-payments. To remedy this, Congress could work to cap annual out-of-pocket costs in Medicare, smooth out-of-pocket liability over the course of a given benefit year to prevent front-loading financial burden, or implement other benefit design changes that would move beneficiaries quickly through benefit thresholds so they reach less burdensome co-pay tiers faster.

Unhelpfully, the Trump administration has been considering changes to Medicare benefit design that would make it more difficult for many Americans to obtain the new medical innovations they might need. One such proposal would limit Americans’ access to medications unless they appear on an “international index” of what other countries make available on their own formularies. This is particularly detrimental for patients who are waiting for breakthrough therapeutics or need access to any new medical innovations coming to market.

Now more than ever, access to new medicines is paramount to ensuring everyone, including our most vulnerable populations, can get the therapeutics they need when they need them. As emergency response gives way to population resilience efforts, Congress should consider structural moves that will lower costs at the pharmacy counter while continuing the incentivize the development of new therapies we all may depend on.

Ray Miller is president and chief executive of Vets Place Northwest — Welcome Home. He lives in Marysville.