Copy
View this email in your browser

Aimed Monthly, Volume 2, Issue 10

Welcome to Volume 2, Issue 10 of Aimed Monthly! This month’s issue includes the latest advocacy and regulatory developments regarding copay accumulator programs, sign-on opportunities, our updated Medicare open enrollment brochure, a new transparency rule, and more.

Highlights

Two Sign-On Opportunities Regarding Copay Accumulator Programs

Aimed Alliance is leading an effort to send letters to UnitedHealthcare (UHC) and WEA Trust, two health plans that intend to implement copay accumulator programs for prescription medications that are offered as part of the plans’ medical benefits. Medications offered as a medical benefit are typically physician administered medications, such as infusions and injections. They tend to treat serious conditions, such as cancer, rheumatoid arthritis, bleeding disorders, and multiple sclerosis, to name a few. In the letters, we encourage the health plans not to implement such policies because copay accumulator programs can reduce patients’ ability access and afford life-saving treatments. This is especially important during the COVID-19 pandemic, given that many of the conditions for which these medications treat are underlying conditions for which there is a serious risk of severe illness from COVID-19, and as a result, the Centers for Disease Control and Prevention (CDC) has recommended that patients remain on their current treatment program unless their health care practitioner tells them otherwise.
 
You can view the UHC letter here and the WEA Trust letter here. To sign on, email policy@aimedalliance.org.
Aimed Alliance and NORM Release and Updated Medicare Open Enrollment Brochure

Medicare open enrollment runs from October 15, 2020 to December 7, 2020. Aimed Alliance and the National Organization of Rheumatology Management (NORM) have released their “2021 Medicare Open Enrollment” brochure with information updated for the 2021 plan year. This brochure serves as a valuable resource for individuals determining which Medicare plan is best for their needs. You can find the brochure here.
Aimed Alliance Launches New Coalition 

This month, Aimed Alliance launched the Alliance for Depression Care Access (ADCA), which is a coalition of likeminded organizations that advocates on behalf of patients with depression. The mission of ADCA is to ensure that patients living with depression can access treatments and services that are appropriate for them.
 
Rates of depression have increased significantly during the COVID-19 pandemic, and ADCA will work to ensure that new patients are able to obtain diagnosis and treatment and stable patients can remain on their current medications. To learn more about ADCA, click here. If you are interested in joining ADCA, please contact us at policy@aimedalliance.org.
CMS Transparency Rule

On October 29, 2020, the Centers for Medicare and Medicaid Services (CMS) released a new rule aimed at improving transparency in health plans. Among other things, it requires group health plans to release a statement to consumers disclosing their cost-sharing requirements with respect to a certain treatment or service. The same statement must also include information about whether the plan has adopted a copay accumulator program (i.e., whether the plan will exclude copay assistance or other third-party payments from the calculation of the patient’s deductible or out-of-pocket maximum). The health plan must make this information available through an internet-based self-service tool, and the information provided in that tool must be in plain language, without a subscription or other fee, and offered in real-time. This information must also be available in plain language in paper format and without a fee upon request of the patient.
 
This change will go into effect for plans beginning on or after January 1, 2023 with respect to a list of 500 items and services, which will be posted on a publicly available website, and on or after January 1, 2024 for the remainder of covered items and services. Read the rule in its entirety here.
Congress Sends Sign-on Letter to CMS Regarding the Medicaid Value-Based Purchasing Rule

Last week, 36 members of Congress signed and sent a letter led by Rep. Brett Guthrie and Rep. Markwayne Mullin to CMS asking the agency to remove the copay accumulator provisions in the proposed Medicaid Value-Based Arrangement rule. The rule, if finalized, would require drug manufacturers’ copay assistance to count toward the calculation of a drug’s Medicaid best price if a health plan has adopted a copay accumulator program. As members of Congress noted, this policy could result in restrictions on patient assistance programs, which would be especially detrimental during the pandemic. The letter also highlights problems with the proposed rule’s redefinition of “line extension,” which could potentially lead to less innovation.
 
Prior to the letter going out, Aimed Alliance had reached out to Rep. Guthrie’s office to encourage him to lead this effort, so we are pleased to see such support for this initiative. Read the letter here.

Legislative Update


This month, Ohio introduced HB 779, a new bill that would prohibit pharmacy benefit managers (PBMs) from 1) requiring plan enrollees to obtain a prescription drug through a mail-order pharmacy or other delivery service; and 2) charge a plan enrollee more for using a retail pharmacy than for using a mail-order pharmacy or other delivery service.

Media Coverage


Honolulu Civil Beat Covers Aimed Alliance Report on the Hawai’i Health Care System
 
On October 4, 2020, the Honolulu Civil Beat published an article written by Dr. Stephen B. Kemble titled “Hawaii Was Creating a Plan for Universal Health Care. It’s Time to Return to It.” The article highlights findings from Aimed Alliance’s recent report “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i” to support the argument that Hawai’i physicians are currently struggling to maintain their incomes. As a result, physicians are spending less time with each patient and tend to avoid sicker and more complex patients. Ultimately, Dr. Kemble calls on the Hawaiian legislature to reform the health care system and make it more cost-effective while allowing for quality care and appropriate physician compensation. Read the article here.

Events


Aimed Alliance will be presenting “Migraine in the Workplace: Legal Protections for Employees” during Miles for Migraine’s upcoming Denver Education Day 2020. This virtual event will take place on December 5, 2020 from 10:00 am to 11:00 am MST. Register here.

Where We've Been

In Case You Missed It


Supreme Court Heard Arguments in PBM Case
 
On October 6, 2020, the Supreme Court of the United States heard oral arguments in Rutledge v. Pharmacy Care Management Association (PCMA). At issue is whether states have the authority to regulate PBMs or whether such laws are preempted by ERISA. PCMA, the association of PBMs, challenged an Arkansas law that required PBMs to reimburse pharmacies, at a minimum, the price the pharmacies pay for generic medications and allows pharmacies to challenge PBM reimbursement rates, among other things. While the solicitor general of Arkansas argued that the state’s law regulated only the relationship between the PBM and the pharmacy rather than the plan (upon which ERISA focuses), several justices appeared to be skeptical of the argument. If the Supreme Court rules that the law is invalid, laws governing PBMs in over 40 states could be in jeopardy, and federal government alone may have authority over PBMs. Read more here.

Contact Us
Questions, comments, suggestions, or feedback? Send us an email.
Copyright © 2020 Aimed Alliance, All rights reserved.


Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.

Email Marketing Powered by Mailchimp