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Aimed Monthly, Volume 3, Issue 6

Welcome to Volume 3, Issue 6 of Aimed Monthly. This month’s issue includes the latest advocacy and regulatory developments regarding state-mandated marijuana coverage, drug pricing, step therapy, prior authorization, copay accumulator programs, and more.

Highlights

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.
New Publication: Health Coverage of Certain Cannabis Products Pose Risks

Seton Hall Legislative Journal recently published Dazed and Confused: Making Sense of Employers’ Risks from Mandated Coverage of Non-FDA-Approved Cannabis Products,” a scholarly article written by Aimed Alliance counsel, Stacey Worthy and Shruti Kulkarni. The article features analysis on risks associated with insurance mandates of non-FDA-approved cannabis products. Recently, states such as Hawaii and New Jersey have introduced legislation that would require health plans and/or workers’ compensation programs to cover such products. However, the article concludes that coverage of non-FDA-approved cannabis products pose health and safety risks to employees and liability risks for their employers. Furthermore, these state bills conflict with or are preempted by existing federal laws. The publication can be read in full here.
Aimed Alliance Weighs in on Oregon "Prescription Drug Affordability Board" Bill

On June 23, 2021, Aimed Alliance sent a letter to the Oregon Senate in opposition to SB 844, a bill that would create the Prescription Drug Affordability Board. The Board would set price caps for prescription drugs that it determines are too expensive. Health care providers would not be permitted to bill more than the Board-established price for a prescription drug regardless of whether the drug is dispensed or administered. If manufacturers or other parties do not comply with price concessions, the Board would be able to request an injunction and restitution. Yet, price caps can reduce innovation and limit patient access to medically necessary treatments. Also, SB 844 could result in significant revenue loss for health care providers. To learn more, read our letter here.
 
Aimed Alliance Sends Letter to BCBS Excellus to Request Improved Access for Lung Cancer Therapy

On June 25, 2021, Aimed Alliance sent a sign-on letter to BCBS Excellus, expressing our concern over a recent decision to reduce coverage of a programmed cell death protein 1 blocking antibodies treatment (anti-PD-1), in the middle of the plan year. The change effectively excluded the medication from coverage, leaving vulnerable patients with non-small cell lung cancer (NSCLC) without access to it. We recommended that Excellus amend its prior authorization policy to remove the step therapy requirements for patients with advanced NSCLC whose tumors have high PD-L1 expression. Read the letter in full here.
Aimed Alliance Comments on CMS's Proposed Inpatient Prospective Payment Systems Rule

On June 28, 2021, Aimed Alliance submitted a comment to the Centers for Medicare and Medicaid Services (CMS) thanking the agency for extending the new technology add-on payment (NTAP) expiration for coagulation factor Xa (recombinant), inactivated-zhzo through FY 2022. To avoid future disruptions in access to care, we requested that CMS identify and put into place a new payment mechanism by the end of FY 2022. If CMS is unable to do so by that point, we requested that the NTAP expiration be extended for another year. Read our comment here.
Aimed Alliance Sends Second Letter in Support of Pennsylvania Step Therapy and Prior Authorization Bill

On June 21, 2021, Aimed Alliance sent the Pennsylvania State Senate Banking and Insurance Committee a second letter in support of SB 225, a bill to establish step therapy and prior authorization reforms. Read our letter here.
Raise Your Voices for Chronic Disease Month

July is Chronic Disease Month. Help educate, empower, and connect advocates for chronic diseases all month long by using #CDM21 and tagging @ChronicRights.
 
Six in ten Americans live with at least one chronic disease, like heart disease and stroke, cancer, or diabetes. These and other chronic diseases are the leading causes of death and disability in America. Ensuring individuals with chronic disease are represented at the local and national level is crucial to improve access to care for patients with these conditions.
 
Amplify chronic voices this month and receive over a dozen social media graphics created by our friends at the Chronic Disease Coalition by using this link: https://rb.gy/le3aom

Legislative Update


Copay Accumulator Programs
 
Connecticut and Louisiana became the latest states to enact copay accumulator program laws.
 
Connecticut’s law requires health carriers, pharmacy benefit managers, and managed care organizations to count any discounts or payment made by a third party on behalf of a plan enrollee toward the enrollee’s coinsurance, copayment, deductible, and other out-of-pocket expenses for a covered prescription drug benefit.
 
Louisiana’s law requires health insurers to include any cost-sharing amounts paid by or on behalf of the enrollee when calculating an enrollee’s contribution toward any applicable cost-sharing requirement.
 

Nonmedical Switching
 
This month, Connecticut Governor Ned Lamont signed H.B. 6622 into law. The new law prohibits certain negative midyear formulary changes. In particular, the bill prohibits plans from removing a prescription drug from the formulary or increasing cost-sharing for the prescription drug above $40 per month after the plan year has begun.
 

Drug Pricing
 
Colorado Governor Jared Polis signed SB 175 into the law. The bill creates a prescription drug affordability review board, which could set arbitrary price caps on prescription drugs and potentially leave vulnerable patients without access to these medications. Aimed Alliance opposed this bill out of concern that it would reduce innovation and access to care.
 

Rare Disease Advisory Council
 
On June 21, 2021, Florida Governor Ron DeSantis signed SB 272 into law creating the Rare Disease Advisory Council. The Council is tasked with providing recommendation to improve the health outcomes of Floridians who have a rare disease.
 
Likewise, New Jersey passed SB 2682, which establishes a 20-member Rare Disease Advisory Council to examine the treatment and services provided to persons with rare diseases in the state. The bill is expected to be signed any day now.
 

Thyroid Eye Disease Week
 
Both Louisiana and New York enacted bills designating November 14-20, 2021 as Thyroid Eye Disease Awareness Week.

Where We've Been

In Case You Missed It

The Supreme Court Upheld the ACA in California v. Texas
 
On June 17, 2021, the Supreme Court of the United States released an opinion upholding the Patient Protection and Affordable Care Act (ACA) in California v. Texas. In that case, plaintiff states challenged the constitutionality of the ACA in its entirety as a result of the Tax Cuts and Jobs Act zeroing out the penalty associated with the individual mandate. The Court held that the defendants did not have legal standing to challenge the ACA because they could not establish how they would suffer past or future injury fairly traceable to the allegedly unlawful conduct (i.e., enforcing the zeroed out individual mandate). If the ACA had been struck down, 31 million Americans could have lost health coverage.

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