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Aimed Monthly, Volume 2, Issue 6

Welcome to the June 2020 issue of Aimed Monthly. This month’s issue includes the latest policy, advocacy, and regulatory developments regarding copay accumulators, nonmedical switching, surprise billing, and nondiscrimination protections. It also includes new resources, such as a fact sheet on copay accumulators for state policymakers and an updated glossary of common health insurance terms for consumers.

Highlights

Aimed Alliance Encourages Congress to Act on Copay Accumulator Protections

On June 3, Aimed Alliance, in collaboration with Patients Rising Now, sent thank you letters to 74 members of the U.S. House of Representatives. At Aimed Alliance’s and Patients Rising Now’s urging, the members had written a letter calling on the Department of Health and Human Services (HHS) to implement certain patient protections into its Notice of Benefit and Payment Parameters for 2021 (NBPP 2021). More specifically, the members asked the agency to prohibit health insurers from using copay accumulators unless patients have access to both a generic and brand medication. Copay accumulator programs are health insurance policies that prevent copay assistance from counting toward a patient’s annual deductible or maximum out-of-pocket limit.

Yet, in May 2020, HHS released the final NBPP 2021 without implementing that recommendation. In response, Aimed Alliance and Patients Rising Now encouraged the 74 members to again reach out to HHS and ask that the agency implement patient protections regarding copay accumulators. Read our letter here
New Fact Sheet Explains Why States Should Pass Laws to Limit Copay Accumulators

Aimed Alliance released a fact sheet that explains why states can and should pass laws that limit health insurers’ use of copay accumulator programs. As health care costs in the U.S. continue to rise, an increasing amount of out-of-pocket costs are shifted onto patients. Yet, many patients have less available income due to the economic impact of the COVID-19 public health emergency. Our fact sheet explains that states not only have the authority to pass patient-focused legislation to limit the use of copay accumulator programs in light of the final NBPP 2021, but should pass such laws to protect their communities.
Aimed Alliance Asks Congress to Improve Access to Care During Public Health Emergency

On June 3, 2020, Aimed Alliance and 18 other patient advocacy groups sent a letter to Congress, asking it to temporarily prohibit prior authorization and step therapy requirements during the COVID-19 pandemic. Prior authorization is a health insurance policy in which health care practitioners must obtain permission from the health plan before prescribing or administering treatments and medical services. Step therapy is a policy in which the health plan requires patients to try and fail on the plan’s preferred medications before patients can access the one that their health care provider prescribed. Both prior authorization and step therapy delay access to medically necessary, patient-centered care. The COVID-19 public health emergency has further exacerbated those delays. Many physicians’ offices and clinics have stopped in-person appointments and furloughed administrative staff during the pandemic, making it difficult to complete the paperwork required for prior authorization approvals and step therapy exception requests. As such, we called on Congress to suspend these practices for the duration of the public health emergency. Read our letter here.
 
Aimed Alliance Called on Ohio Policymakers to Act on Nonmedical Switching and Copay Accumulator Legislation 

On June 1, 2020, Aimed Alliance sent two letters to the Ohio House Health Committee members. In the first, we asked the Committee to bring H.B. 418 to the floor for discussion and to pass the bill. The bill would prohibit health insurers from making negative changes to their formularies, including by dropping a medication from coverage or increasing out-of-pocket costs—activities that often result in nonmedical switching. Read our letter here.
 
In the second letter, we urged the Committee to pass H.B. 469. If signed into law, the bill would prohibit health insurers from adopting copay accumulator programs for branded drugs unless a medically appropriate generic equivalent is available. To read our letter in full, click here
Our Updated Glossary of Health Terms is Now Available 

Aimed Alliance recently updated its glossary of common health terms. Much of the jargon used by the health care industry is complex and confusing. This resource explains many of those terms in simple language. Check it out here.

Legislative Update

  • Louisiana Enacts Stronger Step Therapy Legislation
    • On June 11, 2020, Louisiana Governor John Bel Edwards signed HB 263 into law. The new law includes stronger step therapy protections. Building upon existing protections, the new law requires step therapy protocols to be based on clinical review criteria and clinical practice guidelines, implements timelines in which health plans are required to respond to exception requests, and allows for additional criteria in which patients are eligible for exceptions, among other changes. Read more here.
  • Georgia Surprise Billing Legislation Awaiting Governor’s Signature
    • On June 17, 2020, Georgia lawmakers approved HB 888, which addresses surprise medical bills. The legislation prohibits health insurers from billing patients for emergency services even if the health care provider is outside of the company’s coverage network. The bill is intended to lower health care costs for patients, add pricing transparency, and remove patients from billing negotiations between health insurers and health care providers. Governor Brian Kemp is expected to sign the bill soon, given that surprise billing reform was one of his top priorities for the 2020 session. Read more here.

Media Coverage


Over the past month, our report Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i has received significant media attention, including: Other news outlets covering the report include the Washington Times, the Houston Chronicle, the Albany Times Union, SF Gate, KITV 4 ABC, the Garden Island, West Hawaii Today, and Insurance Journal.
 

Events


Aimed Alliance representatives will be presenting at the following conferences over the next couple of months:

In Case You Missed It


On June 12, 2020, the Office for Civil Rights (OCR) within HHS released its final rule on section 1557 of the Patient Protection and Affordable Care Act, otherwise known as the nondiscrimination rule. In the final rule, OCR rolled back protections against discrimination in health care based on sex stereotyping and gender identity. The final rule eliminates the following:
  • Definitions of key terms, such as “covered entity” and “on the basis of sex” (in the preamble of the rule, HHS states that “sex” will be interpreted solely as “biological sex” or a person’s genetic sex at birth; covered entity now excludes employer-sponsored health plans); 
  • Specific nondiscrimination protections based on sex, gender identity, and association;
  • Major language access requirements (e.g., covered entities no longer have to include taglines translated into different languages on notices and significant communications to consumers);
  • Notice requirements for which covered entities must post information about Section 1557 and nondiscrimination at its locations and on its website;
  • Requirements to have a compliance coordinator and written grievance procedure to handle complaints about alleged violations of Section 1557; and
  • Various enforcement-related provisions, such as protections against intimidation and retaliation.
 
The rule also eliminates certain explicit nondiscrimination protections for individuals in the LBGTQ community, including nondiscrimination standards for qualified health plans and marketplace exchanges. Read more here.
 
Aimed Alliance submitted a comment in opposition to the proposed rule back on August 12, 2019. Read that comment here.
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