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Aimed Monthly, Volume 2, Issue 11

Welcome to Volume 2, Issue 11 of Aimed Monthly! This month’s issue includes the latest advocacy and regulatory developments regarding copay accumulator programs, marijuana legislation, and drug pricing.

Highlights

UHC Delays Its Copay Accumulator Policy Days After Receiving Sign-On Letter

Just days after Aimed Alliance sent UnitedHealthcare (UHC) a letter signed by 62 patient advocacy groups and professional associations, the insurer announced that it would delay the implementation of its copay accumulator policy. Read our letter here and UHC’s statement here. The program will not take effect on January 1, 2021 as previously communicated. UHC acknowledged that it is delaying the implementation of the program due to recent feedback it received from healthcare professionals.
Aimed Alliance Opposes New Jersey Bill that Would Mandate Coverage of Non-FDA-Approved Cannabis Products

New Jersey recently introduced an amendment to NJ A. 1708, which would mandate that various health plans and the workers’ compensation program cover non-FDA-approved cannabis products as a health benefit. Aimed Alliance sent a letter in opposition to this bill because the bill (1) conflicts with current state and federal law, and therefore, is invalid; and (2) poses health and safety risks to New Jersey residents because it promotes the use of illicit substances to treat medical conditions, despite a lack of evidence of safety and efficacy of such substances. Read the letter here.
CMS Issues Interim Final Rule Implementing Most Favored Nation Model for Part B Medications and Biologics

CMS issued an Interim Final Rule to implement the Most Favored Nation (MFN) payment model as a Centers for Medicare and Medicaid Innovation (CMMI) demonstration project. The payment model is intended to lower prescription drug costs. Under the MFN model, Medicare would pay no more for certain Medicare Part B drugs than the lowest price available in other countries similar to the U.S. The MFN Model will also pay providers a flat add-on amount for each dose of an MFN drug, instead of a percentage of each drug’s cost, removing the tie between drug cost and the add-on amount. While Aimed Alliance strongly supports efforts to make medications more affordable, Part B medications are often reserved for patients with chronic, hard to treat conditions, and this a policy may reduce innovation. Price caps could lead to drug rationing and reduced access to new treatments for vulnerable populations. Read the IFR here.

Legislative Update


This week, Congress is focused on negotiating a funding deal to avoid a government shutdown and trying to reach bipartisan consensus to enact an additional COVID-19 relief bill before year’s end. Congress has until December 11 to pass a bill to fund the government and avoid a shutdown. House and Senate Appropriations committees reached an agreement last week on how to divvy up about $1.4 trillion in discretionary spending for fiscal 2021 moving one step closer to the passage of the bill. Lawmakers in both parties also want to pass an additional COVI9-19 relief bill, especially with several provisions passed earlier this year set to expire at the end of December.
 
Additionally, a House vote to federally decriminalize marijuana by removing it from the Controlled Substances Act is expected on Friday. Support for the measure appears to be boosted by November ballot measures that legalized all marijuana in Arizona, Montana, New Jersey and South Dakota and medical marijuana in Mississippi. Read more here.

Events

  • The Society for Human Resource Management (SHRM) is offering a FREE webinar sponsored by Aimed Alliance. The webinar, titled “Mandated Coverage of Marijuana as a Health Benefit? What Employers Need to Know,” will be held tomorrow, December 2, 2020 from 12:00 pm ET to 1:00 pm ET. It will feature a discussion of recent efforts to cover cannabidiol (CBD) as a health and workers’ compensation benefit, and the impact of those efforts on employees and employers.
  • On December 2, 2020, Aimed Alliance’s counsel, Stacey Worthy, will participate as a panelist at the 3rd Annual Pharma Pricing, Reimbursement & Market Access 2020. The presentation entitled “Delivering Patient-Centric Care” will discuss opportunities for meaningfully engaging patients in medicines research, development & delivery; understanding patients’ unmet needs; best practices for collecting and incorporating patient insights; driving next generation patient-centric platforms and engagement and bridging communication gap between medical doctors and patients.
  • Aimed Alliance counsel, Stacey Worthy, will also be a panelist in session titled “Impact of Co-Pay Accumulators on Patient Prescription Drug Costs” at the National Black Caucus of State Legislators’ Annual Conference. The conference takes place from November 30 to December 5, and the session will be available on-demand.
  • 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.

In Case You Missed It


On November 10, 2020, the U.S. Supreme Court heard oral arguments on the constitutional challenge to the Patient Protection and Affordable Care Act (ACA). The case, California v. Texas, was originally brought by state attorneys general and individuals after the ACA’s individual mandate nullified as part of the 2017 Tax Cuts and Jobs Act (TCJA). The oral arguments focused on whether the plaintiffs have standing to bring the lawsuit, whether the TCJA rendered the individual mandate unconstitutional, and if the individual mandate is unconstitutional, whether it is severable from the remaining portions of the ACA, (i.e. the remaining portions of the ACA are still valid). Based on questions asked by the justices, the Court appears poised to uphold the majority of the ACA even if the individual mandate is deemed unconstitutional.

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