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Aimed Monthly, Volume 2, Issue 2

Welcome to Volume 2, Issue 2 of Aimed Monthly! We have several important developments that we are eager to share with you, including state legislative updates and federal updates on copay accumulator policies. Start reading below!

Highlights

2019 Annual Report
On February 13, 2020, Aimed Alliance released its 2019 Annual Report, which provides an overview of the organization’s progress in 2019. You can review our Annual Report to learn more about the organization, its staff, and projects that we completed during the year here. If you’d like to view annual reports from previous years, you can view those here.
NBPP Comment
On January 31, 2020, the Centers for Medicare & Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters for 2021 (NBPP 2021). The Notice of Benefit and Payment Parameters is an annual rule that outlines the benefit and payment policies that will govern health plans in the coming year. For the 2021 plan year, CMS has proposed to allow health plans to exclude the value of third-party financial assistance used from the calculation of enrollees' cost-sharing requirements, including deductibles and maximum out-of-pocket costs. This policy is known as a "copay accumulator," and it has grown in popularity among health plans in recent years.

The proposed copay accumulator policy is a shift from the rule that CMS proposed last year in the Notice of Benefit and Payment Parameters for 2020 (NBPP 2020), which would have only allowed health plans adopt copay accumulator programs when plan enrollees filled a prescription for a brand drug that had a generic equivalent.
 
On February 23, 2020, Aimed Alliance submitted a comment to CMS, opposing the NBPP 2021 copay accumulator rule and requesting that the NBPP 2020 rule be reinstated and enforced. Review our comment to learn more about this issue.
CBD Safety 
This month, we published interactive maps on our website that track active legislation and enacted laws pertaining to good manufacturing practices, testing, marketing, and advertising of food, drug, and cosmetic products containing cannabidiol (CBD). Click here to explore what laws your state has passed and here to explore recently introduced bills.
Texas v. Azar 
The lawsuit challenging the constitutionality of the Patient Protection and Affordable Care Act (ACA) continues to advance through the federal court system. After a coalition of state attorneys general petitioned the Supreme Court of the United States (SCOTUS) in December 2019 to grant expedited review of the case during the Court’s current term, the opposing parties, including the U.S. Solicitor General and the U.S. Department of Justice, submitted briefs arguing that the Court should not review the case before the U.S. District Court for the Northern District of Texas re-hears the case on remand. SCOTUS will likely decide whether to hear Texas v. Azar during the Court’s upcoming conference on February 28, 2020.
 
Review our Texas v. Azar summary page to learn more about this lawsuit and the impact it could have on the U.S. health care system.
Oregon Dialysis Letter 
In January 2020, Oregon legislators introduced HB 4114, which would fix payments for dialysis treatment at the Medicare payment rate. The Medicare payment rate is not high enough for many dialysis clinics to cover the cost of providing treatment. If enacted, this legislation may result in dialysis clinic closures in the state, which would jeopardize patients’ access to care. On February 3, 2020, Aimed Alliance submitted a letter to members of the Oregon House Committee on Health Care, which urged members of the committee to vote against the bill during the committee hearing on February 4, 2020. Read the letter to learn more about this issue.

Legislative Update

  • OH HB 418
    • Introduced on November 19, 2020, this bill would prohibit health plans from limiting or restricting coverage of prescription drugs in the middle of the plan year. The Ohio House Committee on Health held hearings on this bill on January 21, January 28, and February 4. Aimed Alliance submitted testimony in support of this legislation, which you can view here.
  • OH HB 469
    • Introduced on January 14, 2020, this bill would require health plans to include amounts paid by and on behalf of enrollees when calculating their contribution towards their cost-sharing requirements. The Ohio House Health Committee held a hearing on this bill on February 18, 2020. You can view that hearing here.
  • WV SB 762
    • Introduced on February 13, 2020, this bill would prohibit health plans from limiting or excluding coverage of biologic products in the middle of the plan year. On February 20, 2020, the West Virginia Senate Committee on Health and Human Resources unanimously passed the bill.
       

Media Coverage

Events

  • Colorado State University Conference
    • On April 5, 2020, Aimed Alliance Counsel Stacey L. Worthy will be presenting at Colorado State University’s Institute of Cannabis Research Conference 2020. Ms. Worthy’s presentation is titled “Finding a Path Forward: The Legal and Regulatory Status of CBD.”

In Case You Missed It

  • CMS Block Grant
    • On January 30, 2020, CMS announced the “Healthy Adult Opportunity” demonstration program, which will allow participating states to adopt a closed formulary in exchange for accepting a fixed cap on their Medicaid funding in a block grant. If a state chooses to adopt a closed formulary, it will no longer be required to cover all prescription drugs. Instead, it would only be required to cover a portion of the medications in each class. Proponents of closed formularies favor the policy because it could improve the ability of states to negotiate with pharmaceutical manufacturers over drug prices. However, closed formularies inherently limit the medications available to Medicaid enrollees, which potentially puts their health at risk.
  • GA Sec. 1332 Waiver Application
    • On February 6, 2020, CMS confirmed that the reinsurance portion of Georgia’s Sec. 1332 waiver application is complete and will begin to review it. However, the agency requested additional information on the remaining portions, which include proposals for the state to exit the federal insurance marketplace, to rely on private organizations to handle insurance enrollment, and to transform federal health insurance subsidies into a state-run program with a funding cap, among others. These proposals could have negative impacts on patient access to care, which should invite scrutiny from CMS. The 180-day notice-and-comment period on these proposals will begin after CMS determines that the remainder of the waiver application is complete.
  • Gresham v. Azar
    • On February 14, 2020, the U.S. Court of Appeals for the D.C. Circuit issued its decision in Gresham v. Azar, holding that the approval of work requirements in Arkansas’s Medicaid program was arbitrary and capricious. This ruling will likely pave the way for other Medicaid work requirement proposals to be invalidated as the issue heads toward the Supreme Court.
Contact Us
Questions, comments, suggestions, or feedback? Send us an email.
Copyright © 2020 Aimed Alliance, All rights reserved.


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