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Aimed Monthly, Volume 2, Issue 1

Welcome to Volume 2, Issue 1 of Aimed Monthly! Have you enjoyed receiving monthly updates from Aimed Alliance? Send us your feedback about our newsletter to let us know how it could be improved.
Below we have some exciting updates for you as the first month of 2020 draws to a close. This includes the publication of a three-part series of reports that discuss how well health plans are complying with recently enacted prior authorization and step therapy laws, a new section on the Aimed Alliance website that includes summaries of health care lawsuits that are working their way through the judicial system, and a guide that compares the United States and German health care systems. Start reading below!


Reporting on State Law Compliance
Between December 2019 and January 2020, Aimed Alliance published a series of reports titled “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States.” These reports are based on recent surveys commissioned by Aimed Alliance, which gauge the degree to which health plans are complying with recently enacted prior authorization and step therapy laws and whether states are doing enough to enforce those laws. Included in this series is an analysis of Illinois, New York, and Texas. Generally, these reports found that current laws leave many gaps that states need to address and included recommendations for actions that can be taken to protect consumers from unreasonable prior authorization and step therapy policies. You can view the Illinois report here, the New York report here, and the Texas report here.
Health Care Lawsuit Updates
We recently launched a new section on our website that includes up-to-date information regarding ongoing lawsuits involving health care reform, including challenges to the Patient Protection and Affordable Care Act (ACA), short-term limited-duration health plans, association health plans, and Medicaid work requirements. Also included are lawsuits regarding regulation of pharmacy benefit managers (PBMs). For example, you can find a summary of Rutledge v. Pharmaceutical Care Management Association, a case in which the Supreme Court of the United States may determine whether states have authority over certain PBM activities.
This new section includes case histories, summaries of the events that led to each case being filed, descriptions of major decisions in each case, and how the outcome of each case could impact consumers. Be sure to check back periodically to see how these cases have progressed, and stay tuned for additional lawsuits to be included.
Informing the Health Care Reform Debate 
Understanding the commonalities and differences between the United States health system and those used by other countries could assist policymakers weigh possible health care reforms. On January 13, 2020, Aimed Alliance published a guide that discusses the features of the U.S. and German health systems. This guide weighs different components of these health systems, including forms of coverage, premiums, required and optional benefits, how drug prices are established, cost-sharing for treatments and services, how treatments and services are financed, and competition. The guide also features a table that compares each component of the two health systems and a table that contrasts the differences between the U.S. essential health benefits and the benefits that German health insurers must offer. You can review the guide here.

Legislative Update

  • So far in 2020, lawmakers in five states have introduced new legislation that would limit copay accumulator programs, including Florida, Indiana, Kentucky, Ohio, and West Virginia. Additionally, bills introduced last year in Massachusetts, North Carolina, and Pennsylvania are still active. These bills generally require health plans to include cost-sharing amounts paid on behalf of enrollees when calculating their contribution towards deductibles and maximum out of pocket costs.
  • In New Jersey, lawmakers have introduced A2180, which would require health plans to use uniform paperwork for prior authorization requests, in addition to requiring health plans to accept prior authorization paperwork electronically.
  • In New Hampshire, lawmakers have introduced S 690, which would prohibit health plans from removing medications from their formularies in the middle of the plan year. New Hampshire lawmakers have also introduced S 691, which would require health plans to act on a prior authorization request within 48 hours.
  • In Ohio, lawmakers have introduced HB 418, which would prohibit health plans from removing medications from their formularies in the middle of the plan year.


  • DCAN Patient Advocacy Training
    • On January 29, 2020, Aimed Alliance counsel Stacey Worthy will be speaking at Derma Care Access Network's patient advocacy training, which will take place from 9:30am to 1:00pm at the Omni Parker House in Boston, Massachusetts. To register for this free event, click here to access the event invitation. Breakfast and lunch will be provided for event attendees.

Where We've Been

  • CBD Summit
    • On January 15, 2020, Aimed Alliance Counsel Stacey L. Worthy moderated a panel at CBD Summit: A National Dialogue on Public Safety, Research, and Policy titled “Reflections from Consumers, Patients and Healthcare Providers.” The panel included representatives from the American Pharmacists Association, the National Council for Behavioral Health, the American Society of Anesthesiologists, and the National Consumers League. Discussion focused on how consumers, patients, and health care providers are impacted by the availability and accessibility of cannabidiol-based products and concerns highlighting the need for regulators and legislators to take action.

In Case You Missed It

  • Texas v. Azar
    • In late 2019, the U.S. Court of Appeals for the Fifth Circuit upheld the lower court’s ruling in Texas v. Azar that the ACA’s individual mandate is an unconstitutional exercise of Congress’s Tax Power. The Fifth Circuit sent the case back to the District Court to determine which other sections of the ACA and its regulations should also be struck down. In response, on January 3, 2020, a coalition of state attorneys general requested that the Supreme Court of the United States expeditiously review the Court of Appeals’ ruling. On January 10, 2020, the U.S. Solicitor General asked the Supreme Court not to hear the case, and instead, to allow the District Court to make a determination first. Today, the Court decided not to expedite its decision, but did not decide on whether to hear the case now or allow it to go back to the District Court first.
  • Stewart v. Azar
    • In late 2019, Gov. Beshear of Kentucky announced that the state would abandon its plan to implement Medicaid work requirements. He then withdrew the state from Stewart v. Azar, the case challenging Kentucky’s proposed Medicaid work requirements. Without Kentucky participating in the case to defend the work requirements policy, the U.S. Court of Appeals for the District of Columbia Circuit declared the case moot and dismissed it on January 8, 2020.
  • Rutledge v. Pharmaceutical Management Care Association
    • On January 10, 2020, the Supreme Court agreed to hear Rutledge v. Pharmaceutical Care Management Association. This case arose from the Pharmaceutical Care Management Association (PCMA) challenging a state law governing how pharmacy benefit managers (PBMs) reimburse pharmacies. PCMA argued that the law is preempted by the Employee Retirement Income Security Act (ERISA) and Medicare Part D, which the lower courts agreed with. The Supreme Court’s decision in this case will determine how much authority states have to regulate PBMs.
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