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Aimed Monthly, Volume 1, Issue 8

Welcome to Volume 1, Issue 8 of Aimed Monthly! In this issue, we are pleased to present to you our new report on nonmedical switching in health systems in Ohio, recent updates from the Exocrine Pancreatic Insufficiency Coalition (EPIC), our comment on the Administration’s proposed rule to weaken nondiscrimination protections for patients, and an update on lawsuits challenging the Patient Protection and Affordable Care Act (ACA). Start reading below.


Switching in the System
While nonmedical switching typically refers to an insurance practice, Aimed Alliance has identified similar practices employed by hospitals and health systems. Namely, these entities exclude medications from their internal formularies, instruct practitioners to stop prescribing one medication and instead prescribe another, and no longer stock the original medication in their pharmacies. The end result is that the patient is forced to switch medications for nonmedical reasons.
To uncover the extent of these practices, Aimed Alliance surveyed patients and providers in Ohio. Our survey found that nearly 79 percent of physicians practicing in Ohio and employed by a health system have experienced some type of third-party interference in the treatment of their patients. Of these physicians, nearly 87 percent reported that the health system forced their patients to use a medication that was different from the one originally prescribed. Of the physicians whose patients were forced to switch medications, 58 percent found that the new treatment was either less or much less effective at managing the patient’s condition. Review the results of the survey and an article published by to learn more.
EPIC Letters
The Exocrine Pancreatic Insufficiency Coalition (EPIC), a coalition of likeminded organizations convened by Aimed Alliance to advocate on behalf of patients with Exocrine Pancreatic Insufficiency (EPI), sent several letters to insurers and pharmacy benefit managers (PBMs) last month. EPI is a condition that occurs when the human body is unable to provide an adequate supply of digestive enzymes and commonly occurs in individuals with cystic fibrosis and chronic pancreatitis. Patients with this condition are unable to properly digest food, which causes gastrointestinal upset and difficulty absorbing nutrients from the food that they eat.
One letter, sent to CVS Caremark, expressed concern about the PBM’s decision to rescind coverage for a pancreatic enzyme replacement therapy (PERT), which patients with EPI rely on for survival. CVS recently responded to the coalition and indicated that pediatric patients will be allowed to stay on their PERT for the remainder of the plan year. The coalition also sent letters of gratitude to other insurers and PBMs that elected to continue covering PERTs for patients with EPI. Read more.
Deregulating Discrimination in Health Care 
On May 24, 2019, the U.S. Department of Health and Human Services (HHS) proposed several changes to a 2016 regulation implementing Section 1557, the non-discrimination provision of the ACA. Many of the revisions in HHS’s proposed rule would scale back protections against discrimination on the basis of gender, pregnancy, sexual orientation, and gender identity. Additionally, the proposed revisions attempt to save money by eliminating language assistance requirements that individuals with limited English proficiency (LEP) rely on to successfully navigate the U.S. health care system. The proposed rule also would carve out employer-sponsored plans from the scope of the nondiscrimination protections. If finalized, the proposed rule could result in increased discrimination for many Americans when attempting to access health care services in the United States.
On August 12, 2019, Aimed Alliance submitted a comment to HHS, responding to the proposed rule and requesting that it be withdrawn. Read our comment here.
Update on ACA Lawsuits 
The U.S. Court of Appeals for the District of Columba Circuit is currently considering two cases that would challenge the validity of health plans that do not comply with the ACA. Last month, Judge Richard L. Leon of the federal District Court for the District of Columbia upheld a rule that seeks to increase access to short-term plans by making them more available to consumers and loosening restrictions on how long the plans can last. In this ruling, Judge Leon rejected the plaintiff’s arguments that the short-term plan rule was contrary to the intent of Congress when enacting the ACA and the Health Insurance Portability and Accountability Act (HIPAA). On July 29, the short-term plans ruling was appealed to the D.C. Circuit.
In March, Judge John D. Bates of the federal District Court for the District of Columbia invalidated a regulation promulgated by the U.S Department of Labor that aimed to increase access to association health plans (AHPs). The regulation changed the definition of “employer,” which would make it easier for small businesses to band together to form an association for offering health coverage. The association would be considered a single multi-employer plan under the Employee Retirement Income Security Act (ERISA). Judge Bates struck down the agency’s regulation, claiming that it was a clear attempt to subvert the ACA. The Department of Labor’s definition of “employer,” which did not require a commonality of interest, was unreasonable, according to Judge Bates. In May, the D.C. Circuit Court of Appeals granted a request from the Administration for an expedited appeal. Continue reading.


  • Copay Accumulators
    • On Wednesday, October 2, 2019, Aimed Alliance Staff Attorney John A. Wylam, Esq. will be joining Carl Schmid from the AIDS Institute and Anna Hyde from the Arthritis Foundation to deliver a panel presentation on copay accumulator programs at CBI’s Coupon and Copay Conference in Philadelphia, PA.

Where We've Been

  • Joint Webinar
    • On July 31, 2019, Aimed Alliance jointly hosted a webinar with the Headache and Migraine Policy Forum and the Migraine at Work Coalition titled “Preventing Discrimination and Providing Quality Benefits for Employees with Migraine Disease and Other Chronic Conditions.” Click here to view a recording of the webinar.
  • CBI
    • On August 13, 2019, Aimed Alliance counsel Stacey L. Worthy served as a panelist at CBI’s 7th Annual Reimbursement and Access Conference in Philadelphia, PA. She discussed the legal implications of copay accumulator policies in employer-sponsored health plans.

In Case You Missed It

  • AAMC: Primary Care Provider Shortage Expected to Worsen
    • According to new data from the Association of American Medical Colleges (AAMC), the nationwide primary care physician shortage could reach as high as 55,200 by 2032. If the provider shortage is not addressed, patients could experience longer wait times when scheduling future appointments, they may be unable to see their preferred providers, and they could experience long wait times on the day of their appointment. What is causing the shortage? Continue reading.
  • Physician Groups Call for a Public Health Approach to Gun Violence
    • On August 7, 2019, a group of physicians published an article in The Annals of Internal Medicine calling for the implementation of practical policies that would reduce firearm injuries and death. The American Public Health Association (APHA) joined the authors in writing the article, which represents several national physician professional societies: the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, the American College of Surgeons, the American Medical Association, and the American Psychiatric Association. In the article, the physicians advocate for a public health approach to preventing firearm injuries and death, which would include training health care professionals to assess whether patients exhibit a heightened risk of injuring themselves or others and to intervene when necessary. Continue reading.
  • HHS OIG Withdraws Policy Proposals from 1994 and 2002
    • The HHS Office of the Inspector General (OIG) announced on August 2, 2019 that the agency is withdrawing two proposed rules that have been pending for several years. The first rule, originally proposed in 1994, would have allowed OIG to issue civil monetary penalties against hospitals if they knowingly make incentive payments to providers to induce them to reduce the services they provide to Medicare or Medicaid beneficiaries. The second rule, originally proposed in 2002, would have expanded an Anti-Kickback Statute safe harbor to allow waivers of cost-sharing amounts for Medicare Part A and Part B services for enrollees of Medicare SELECT policies. Continue reading.
Contact Us
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