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Aimed Monthly, Volume 1, Issue 3

Welcome to Volume 1, Issue 3 of Aimed Monthly! In this issue, we have several policy updates along with a deep dive into the states that have introduced copay accumulator legislation. Don’t forget to RSVP for the webinars we will be hosting later this month! Start reading below.

Highlights

The Chairman's Request
Sen. Lamar Alexander [R-TN], Chairman of the Health, Education, Labor, and Pensions (HELP) Committee, issued a request for information on December 11, 2018. This request solicited recommendations from health care stakeholders on steps that Congress can take to reduce the cost of health care in the U.S. Aimed Alliance submitted a response to Sen. Alexander’s request, advocating for many reforms that would reduce the cost of care, increase health care access, and protect patients. Our recommendations included: limiting copay accumulators in employer-sponsored health insurance plans, imposing a fiduciary duty on pharmacy benefit managers, requiring pharmaceutical rebates to be passed on to consumers, and more.  Explore our recommendations.
Double Dipping the Deductible
On January 17, 2019, the Centers for Medicare and Medicaid Services (CMS) issued the annual draft Notice of Benefit and Payment Parameters for the 2020 benefit year. This draft regulation contained numerous policy proposals, such as allowing mid-year formulary changes in certain circumstances as well as broader adoption of copay accumulator programs in the private market. Aimed Alliance responded to this proposal and cautioned CMS against pursuing these policies. Review our response.
An Imperfect Assessment 
On January 17, 2019, the Institute for Clinical and Economic Review (ICER) released its draft protocol for the “Unsupported Price Increase Assessment.” This draft protocol outlined the process that ICER will use to determine whether specific medications sold in the U.S. have experienced an unjustified price increase. Aimed Alliance responded to this draft protocol by identifying shortcomings in the assessment’s methodology and expressing our preference for state and federal governments to handle this issue instead. Review our letter to ICER.
 

Events

  • We will be hosting a webinar with the Derma Care Access Network (DCAN) on March 21 from 12:00pm-1:00pm ET. We will be discussing how dermatological conditions may impact employees in the workplace and will provide tips for managing employee benefits. Speakers include a physician, an attorney, a benefits manager, and a third-party payer. All are welcome to attend. You can register for the webinar here.
  • We will be hosting a webinar on March 26 from 12:00pm-1:00pm ET. We will be discussing recent proposals from the federal government designed to reduce systemic health care costs and increase efficiency in the Medicare program and marketplace exchange plans. You can register for the webinar here.

Media Coverage


Below is a list of recent events and publications featuring our work.
  • Aimed Alliance Counsel Stacey L. Worthy has authored an article published in the March issue of HR News discussing copay accumulators and the dangers that they could create for both employees and employers. Read the article.
  • Aimed Alliance Counsel Stacey L. Worthy joined Andrew Schorr from Patient Power on an episode of “Dear Stacey,” discussing copay accumulator programs and how they can impact patients. Listen to the episode.
  • Christel Marchand Aprigliano, the CEO of the Diabetes Patient Advocacy Coalition, authored an op-ed that was published last month by Crains Cleveland Business. In this op-ed, Ms. Aprigliano discusses the dangers that copay accumulators present for diabetes patients who have historically relied on patient assistance from pharmaceutical manufacturers to afford their insulin, and referenced our report Employers Beware, to highlight some of our policy recommendations. Keep reading.
     

Where We've Been


Aimed Alliance staff regularly speak at conferences and other similar events. Below is a list of our recent speaking engagements.
  • On February 12, Aimed Alliance Counsel Stacey L. Worthy participated in a policy panel discussion hosted by The Headache and Migraine Policy Forum at the U.S. Capitol. As a panelist, Ms. Worthy educated patients about legal protections available to them under the Americans with Disabilities Act.

State Legislative Update

  • Texas Rep. Dr. Greg Bonnen has introduced HB 2387 to the Texas Legislature. This bill would require adverse utilization review determinations to be overseen by a physician of the same specialty as the provider of record. It would also define adverse utilization review determinations as the practice of medicine. This bill would place strong guard rails around utilization review determinations, and it would help ensure that the decisions that patients make with their doctor are not needlessly overridden by health insurers.
  • Nine states have introduced legislation that would impact copay accumulator programs:
    • AZ HB 2166
      • This bill would require health plans and PBMs to count payments made on behalf of enrollees when calculating an individual’s out-of-pocket maximum, deductible, and cost-sharing requirements.
    • CT HB 5851
      • This bill would require all entities that offer health insurance coverage to deduct all cost-sharing payments made on behalf of the enrollee by pharmaceutical manufacturers from the individual’s cost-sharing obligations.
    • CT SB 30
      • This bill would outright ban copay accumulator programs.
    • IN HB 1307
      • This bill would require health insurers to count cost-sharing payments made on behalf of an individual towards the individual’s cost-sharing obligations by including third-party payments in the definition of “cost-sharing.”
    • KY HB 374
      • This bill would prohibit insurers from preventing payments made on behalf of an enrollee from counting towards the enrollee’s cost-sharing obligations.
    • MA HB 898/HB 926
      • This bill would require health insurers to calculate third-party payments made on behalf of an enrollee towards that enrollee’s deductible, copay, out-of-pocket maximum, and other cost-sharing obligations.
    • RI S 137
      • This bill would require health insurers to calculate third-party payments made on behalf of an enrollee towards that enrollee’s deductible, copay, out-of-pocket maximum, and other cost-sharing obligations. This would also require pharmaceutical manufacturers to offer patient assistance regardless of an individual’s insurance status.
    • UT SB 223
      • This bill would define patient assistance offered by health care providers and pharmaceutical manufacturers as an improper inducement. This would prohibit pharmaceutical manufacturers from directly offering patient assistance, but non-profit patient assistance programs would still be permitted.
    • VA HB 2515
      • This bill would require health insurers to count payments made by third-parties towards an individual’s overall contribution to an out-of-pocket maximum or cost-sharing requirement.
    • WV HB 2770/SB 509
      • This bill would require insurers and PBMs to include payments made by third-parties in the calculation of cost-sharing amounts.

In Case You Missed It

  • The Alliance for Patient Access (AfPA) recently released a study on nonmedical switching. This study focused on the ways that nonmedical switching impacts patients, including an analysis on the factors that commonly cause insurers to make a mid-year formulary switch and how that switch influences patient outcomes. You can read the study here.
  • The Global Health Living Foundation (GHLF) worked jointly with the Indiana Stable Patient Protection Coalition (ISPPC) and the College of State Rheumatology Organizations (CSRO) to study how nonmedical switching practices are impacting patients in Indiana. This study revealed that 68.9 percent of respondents had been prescribed a medication that was switched by their insurance company. Furthermore, 78.8 percent of respondents found that the new medication was less effective than the one they were originally prescribed. You can read the study here.
Contact Us
Questions, comments, suggestions, or feedback? Send us an email.
Copyright © 2019 Aimed Alliance, All rights reserved.


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