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Aimed Monthly, Volume 3, Issue 7

Welcome to Volume 3, Issue 7 of Aimed Monthly. This month’s issue includes the latest advocacy and regulatory developments regarding copay accumulator programs, nonmedical switching, prior authorization, step therapy, and more.


Aimed Alliance Calls on Federal Agencies to Take Action on Copay Accumulator Programs

On Jul 23, 2021, Aimed Alliance submitted a comment in response to the “Request for Information Regarding Reporting on Pharmacy Benefits and Prescription Drug Costs” (RFI). In the RFI, the U.S. Departments of the Treasury, Labor, and Health and Human Services (“Departments”) proposed that health plans report rebates, fees, and any other remuneration paid by drug manufacturers to the plans. In determining how to define “rebates, fees, and other remunerations,” the Departments asked how to account for manufacturer copay assistance programs, coupon cards, and copay accumulator programs. Aimed Alliance recommended that the Departments 1) exclude copay assistance from the definition of “rebates, fees, and other remuneration”; 2) reinstate patient protections regarding copay accumulator programs; and 3) in the alternative, require insurers to report on copay accumulator programs in efforts to measure harm to patients and identify bad actors. Read our comment here.
Aimed Alliance Reiterates Concerns to Cigna about $500 Debit Card Program

On May 14, 2021, Aimed Alliance initially sent a letter to Cigna to express our concerns about the insurer’s recent decision to offer $500 debit cards to patients if they switch from secukinumab to ixekizumab for nonmedical reasons. Since then, we learned that Cigna has adopted the same program to incentivize stable patients to switch from the infliximab reference product to biosimilars as of July 1, 2021. In response, we sent a follow-up letter reiterating our concerns. More specifically, we are concerned that the debit card program is another form of nonmedical switching. Additionally, the debit card is akin to a kickback or inducement. Read our letter here.
Aimed Alliance Raising Issues with BCBS of Alabama's Prior Authorization Policy for Treatment of Degenerative Eye Diseases

On July 2, 2021, Aimed Alliance sent a letter to Blue Cross Blue Shield of Alabama (BCBS AL) in response to a new prior authorization policy, effective July 1, 2021, for aflibercept. The policy requires patients with neovascular (wet) age-related macular degeneration (Wet AMD), macular edema following retinal vein occlusion (MEfRVO), diabetic macular edema (DME), and diabetic retinopathy (DR) to try and fail on an off-label, compounded medication before accessing aflibercept, which is FDA approved for such conditions. If a medication to treat these eye conditions is ineffective, patients can experience rapid and severe loss of central vision. Therefore, we recommended that BCBS AL amend its prior authorization policy to remove the step therapy requirements for patients with Wet AMD, MEfRVO, DME, and DR. Read the letter here.
Aimed Alliance Supports Massachusetts Step Therapy Legislation

On July 13, 2021, Aimed Alliance joined over 50 other patient advocacy groups and professional associations in urging Massachusetts legislators to pass the step therapy bills, H.1311 and S.756. The bills protect patients by requiring an expeditious appeal process to avoid interrupting continuity of care. The bills also allow for the prescribing provider to override step therapy when medically necessary. Exceptions would also be granted if the patient has already tried, and failed on, the medication required by the insurer. Learn more here.

Legislative Update

Prior Authorization
Texas’s new prior authorization law is set to take effect on September 1, 2021. The law prohibits health insurers from requiring prior authorization for services if a provider earns “gold card” status. A provider can earn the status if they have a 90% prior authorization approval rate. Health plans that require prior authorization must evaluate whether a provider qualifies for the gold card exemption once every six months.

PBM Regulation
Delaware legislation to regulate pharmacy benefit managers (PBMs) passed the Delaware General Assembly late last month and is currently awaiting Governor John Carney’s signature. HB 219 would require would protect pharmacies from receiving unsustainably low reimbursement rates and provide the Department of Insurance with the ability to investigate PBMs, enforce consumer protection measures, and incentivize corrective action through increased regulatory authority.
Likewise, New York recently enacted a law to regulate PBMs. Senate Bill S2507 requires PBMs to register with the state and report on an annual basis any pricing discounts, rebates, inflationary payments, credits, clawbacks, or other incentives received by the PBM.

Media Coverage

Aimed Alliance Op-Ed in New Jersey Star-Ledger
On July 28, 2021, the New Jersey Star-Ledger published an op-ed titled “Why We Shouldn’t Mandate Coverage of Medical Marijuana in New Jersey.” The op-ed was authored by Aimed Alliance counsel, Stacey Worthy.

Aimed Alliance Poll in
On June 14, 2021, published an article titled “Getting an MRI on Your Own Could Save You Money—and Get You Treated Faster.” The article cited to data from a recent Aimed Alliance poll, “Putting Profits Before Patients: Provider Perspectives on health Insurance Barriers that Harm Patients.” 

In Case You Missed It

Aimed Alliance Releases Annual Report

In 2020, Aimed Alliance engaged in a wide array of activities to protect and enhance the rights of health care consumers and providers despite of and in response to the COVID-19 pandemic. We are pleased to share our progress with you. In our 2020 Annual Report, you can review the projects we completed over the course of the year and gain insight into what we plan to do in 2021 and beyond. View our Annual Report here.

Contact Us
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