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Aimed Monthly, Volume 3, Issue 8

Welcome to Volume 3, Issue 8 of Aimed Monthly. This month’s issue includes new staff announcements as well the latest educational, policy, and advocacy developments regarding nonmedical switching, open enrollment, marijuana reform, prior authorization, and more.


Staff Changes

Aimed Alliance would like to welcome our new policy manager, Ashira Vantrees, JD. Ashira is a recent graduate of Florida International University College of Law. She brings extensive research experience on a wide variety of issues, including public health, health education, human rights, women’s rights, and disability rights. Building on her own experiences growing up and facing difficulties in obtaining health care services, Ashira is a passionate advocate for health care accessibility and affordability.  

Prior to attending law school, Ashira worked as a public health emergency planner and outreach coordinator for a health department in Ohio. In addition to her legal degree, Ashira holds a Bachelor of Arts in Emergency Management and Business from Ohio Christian University and a Masters of Science in Disaster Medicine and Management from Thomas Jefferson University.
Announcing the Launch of the Alliance for Mental Health Care Access

Aimed Alliance, in partnership with the Alliance for Patient Access (AfPA), are pleased to announce the launch of the Alliance for Mental Health Care Access (AMHCA). A renewed effort of the previous Alliance for Depression Care Access, AMHCA is a network of likeminded organizations that advocates on behalf of patients with mental health disorders. The mission of AMHCA is to protect stable patients living with mental health disorders from the harmful insurance practice of non-medical switching. If you are interested in joining AMHCA, please contact us.
Aimed Alliance Releases Updated Open Enrollment Brochures
The open enrollment periods for individual, small, large group, and Medicare plans are rapidly approaching. To ensure consumers are able to select the plan that is most appropriate for their needs, we have updated our various brochures, including the following:
Aimed Alliance Submits Comment on the Cannabis Administration and Opportunity Act

On September 1, 2021, Aimed Alliance submitted a comment on the Discussion Draft: Cannabis Administration and Opportunity Act. In particular, we called on Congress to (1) ensure racial justice through cannabis regulation; (2) create an appropriate regulatory pathway for non-FDA-approved cannabidiol (CBD) products to ensure the products are safe and effective; (3) preserve and expand the FDA’s jurisdiction over cannabis products; (4) implement strong safety requirements for cannabis products; and (5) prevent misleading marketing activities.

Legislative Update

New Prior Authorization Bill Signed into Law
On August 19, 2021, Illinois Governor P.B. Pritzker signed into law the Prior Authorization Reform Act, HR 711. To protect patients from improper delays or denials of care, the new law establishes time limits for urgent and non-urgent prior authorization requests. Currently, there are no standard timelines, which has resulted in patients waiting long durations before care can be initiated. The law also ensures that prior authorization requirements are based on medical evidence and that decisions are administered by qualified professionals, and it requires peer-to-peer review to ensure that a physician in the same or similar specialty under review is considering the medical request.

Media Coverage

On August 13, 2021, Aimed Alliance was featured in an article entitled, “Getting an MRI on your own could save you money—and get you treated faster.” The article featured a survey conducted by Aimed Alliance of over 600 primacy care providers, which found that nearly half (48%) of doctors were considering a career change because of their frustrations over insurer policies and delays.” Additionally, 87% of the respondents reported that patients’ conditions have grown worse because of insurance “red-tape regulations,” and 83% worried that patients suffer prolonged pain because of it. Another 91% surveyed believed health insurance policies delayed necessary care for patients.


Telehealth in a Post-Pandemic World
On August 3, 2021, Aimed Alliance hosted a virtual policy briefing for patient advocacy groups and professional associations titled “Telehealth in a Post-Pandemic World: Preserving Gains and Ensuring Access to In-Person Care.” The event included:

  • An overview of how telehealth access has changed over the course of the pandemic
  • An update on policies being considered by CMS and Congress
  • The perspectives of patients and health care providers
  • A discussion of issues for policymakers to consider as they determine how to provide coverage for telehealth and in-person care. 

An executive summary of the event is forthcoming.

Non-Medical Switching and Mental Health
On August 31, 2021, Aimed Alliance and AfPA co-hosted a meeting entitled “Non-Medical Switching and Mental Health: Ensuring Access to Appropriate Care.” This virtual event launched the Alliance for Mental Health Care Access (AMHCA) and featured a collaborative discussion on protecting patients with mental health conditions from the insurance practice of  non-medical switching.

In Case You Missed It

Study Finds Patients Spent $35.8 Billion Due to Payers' Benefit Utilization Techniques

A recent study in Health Affairs found that payers, pharmaceutical manufactures, health care providers, and patients incur approximately $93.3 billion in annual costs on implementing, contesting, and navigating drug utilization management programs. Drug utilization management is a collection of cost reduction techniques and programs used by health insurers. They often involve restricting access to medications (e.g., prior authorization and step therapy) or shifting cost-sharing burdens to patients (e.g., nonmedical switching and copay accumulator programs). As a result, these policies can limit patient access to medically necessary treatments.
The study found that, in 2019:
  • Patients spent nearly $35.8 billion on drug cost-sharing even after taking advantage of copay assistance programs;
  • Health care providers spent nearly $26.7 billion on interactions with payers on behalf of their patients;
  • Pharmaceutical manufacturers spent $24.8 billion on administrative programs, direct financial support, and drug donations related to drug utilization management; and
  • Payers spent $6 billion on the administration of drug prior authorization programs.
Aimed Alliance is committed to working with partners to ensure that prescriptions remain affordable and accessible to patients. To access the full article, click here.

DC Health Link Adopts Recommendations to Reduce Health Disparities

In Fall 2020, the DC Health Benefit Exchange Authority’s Executive Board established a Social Justice and Health Disparities Working Group to examine practices, structures, and policies that can be implemented in the district to (1) expand access to providers and health systems for communities of color; (2) eliminate health outcome disparities for communities of color; and (3) ensure equitable treatment for patients of color in health care services. On July 14, 2021, DC Benefit Health Exchange Authority Executive Board unanimously adopted the Working Group’s recommendations, which included incentivizing both primary care providers and specialists to practice in underserved areas, providing scholarships for students of color to enter the health profession, and creating a five-year goal to improve diversity in networks. The Working Group also suggested potentially modifying certain health plans to eliminate patient cost-sharing requirements, including deductibles, co-insurance, and co-payments for prescription drugs, supplies, and disease management for conditions that disproportionately impact patients of color.

Aimed Alliance supports the DC Benefit Health Exchange Authority’s efforts to address systemic health disparities. The full report from the Working Group can be found here.

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