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Aimed Monthly, Volume 3, Issue 4

Welcome to Volume 3, Issue 4 of Aimed Monthly. This month’s issue includes the latest advocacy and regulatory developments regarding specialty pharmacy practices, health insurance reform, copay accumulator programs, step therapy, and more.
 
We’d also like to welcome back our counsel, Stacey Worthy, from maternity leave

Highlights

New Fact Sheet: White Bagging and Brown Bagging Policies Explained

Over the past few years, health insurers have increasingly begun adopting policies referred to as “white bagging” and “brown bagging,” which require patients with complex, chronic, or rare conditions to obtain certain treatments (i.e., specialty drugs) for administration directly from specialty pharmacies. On April 28, 2021, Aimed Alliance released a new fact sheet titled “White Bagging and Brown Bagging Policies Explained.” The fact sheet explains what these policies are, their benefits and disadvantages, how they impact patients, and steps patients can take in response to such policies. Read our fact sheet here.
Statement to Congress on QALYs

This month, Aimed Alliance was pleased to join over 80 patient groups in calling on Congress to oppose any legislation that uses QALYs to assess the value of prescription medications. As has long been Aimed Alliance’s position, the use of QALYs in value assessments can result in discrimination against certain patient populations, including those with chronic conditions, seniors, and individuals with disabilities, because QALYs assign a lesser value to such lives than “healthy” individuals. Read the statement here.
Letters in Support of Rhode Island Step Therapy Bill

On March 16, Aimed Alliance submitted a letter in support of Rhode Island H5704, which seeks to establish important patient protections for step therapy protocols. Such protections include clinical review criteria based on clinical guidelines and developed by expertise in the medical condition; step therapy exceptions requirements; and appeals processes for the denial of an exception request. These protections would improve timely access to individualized care and may prevent disease progression caused by taking a less effective medication. Read our letter here
American Families Plan Aims to Expand Health Coverage

This week, President Biden released the American Families Plan, which aims to improve access to quality health coverage by making it more affordable. In particular, the plan proposes to expand premium tax credits set forth in the American Rescue Plan. The American Rescue Plan provided two years of lower health insurance premiums for those who buy coverage on their own, which saves families an average of $50 per person each month. The American Families Plan would make those premium reductions permanent, resulting in nine million people saving hundreds of dollars on their premiums each year.

Legislative Update


Copay Accumulators
 
This month, two more states passed legislation to limit copay accumulator programs—Arkansas and Oklahoma.
  • Arkansas’s new law requires health insurers to include cost-sharing amounts paid by or on behalf of the enrollee when calculating an enrollee’s cost-sharing contribution. However, cost-sharing paid on behalf of the enrollee does not count toward that contribution if the enrollee is taking a brand drug for which a generic equivalent is available, and the brand is not considered to be medically necessary by the prescriber.
  • Oklahoma’s new law deems it an unfair claim settlement practice in violation of the Unfair Claims Settlement Practice Act if a health insurer or pharmacy benefit manager fails to include any amount paid by or on behalf of an enrollee toward the enrollee’s out-of-pocket maximum, deductible, copayment, coinsurance, or other cost-sharing requirement.
 
PMB Reform
 
Montana is the latest state to pass a law that provides oversight of pharmacy benefit managers (PBMs). Among other things, the law required license and registration of PBMs; prohibits untrue, deceptive, or misleading advertising; requires transparency and maximum allowable cost reporting; requires network adequacy; and authorizes enforcement authority.
 
Equity-Driven Healthcare Reform
 
The governor of Illinois recently signed the Health Care and Human Services Reform Act into law. The legislation, spearheaded by the Illinois Legislative Black Caucus, builds upon significant administration efforts toward health equity, including the following:
  • Creating a program that will include training and certification, ensuring Illinoisans are better able to access help from trained health workers. Training includes implicit bias training for interns, residents and physicians.
  • Creates the Underlying Causes of Crime and Violence Study Act, which will study how to create a process to identify high violence communities, also known as R3 (Restore, Reinvest, and Renew) areas, and prioritize state dollars to address underlying health issues and underlying causes of violence.
  • Requires a racial equity impact assessment for all future hospital closure applications that is publicly viewable.
  • Creates a taskforce that will review health and human service departments and programs with the goal of improving health and human service outcomes for Illinois residents.
  • Creates a commission to identify and propose statewide policies to eliminate systemic racism.
  • Increases payment rates for psychiatric treatment at hospitals serving primarily low-income patients.

Where We've Been

  • On April 29, Aimed Alliance offered a webinar, “Coverage of Marijuana as a Health Benefit: What Employers Need to Know,” in partnership with the Society for Human Resource Management (SHRM). In this program, physician Maria Lopes examined what employers should consider when selecting employee health plans in an era where the use of medical marijuana among employees is becoming more prevalent. Board-certified psychologist and addiction specialist, Aaron Weiner, discussed the risks and practical implications of legal marijuana use by employees. View an archived version of the webinar here.
  • On April 14, 2021, Aimed Alliance counsel, Shruti Kulkarni, moderated a panel discussion during HealthyWomen’s “Cancer: The Impact of Cancer-Related Financial Burdens on the Emotional Well-Being.” Watch the full webinar here. Read HealthyWomen’s survey report of the same name here.
  • On April 12, 2021, Ms. Kulkarni presented “Migraine in the Workplace: Legal Protections for Employees” during Miles for Migraine’s Migraine in the Workplace: Create Your Advocacy Plan virtual event. View her presentation here.
  • Ms. Kulkarni also appeared on episode 3, “Knowing Your Rights,” of Migraine at Work’s webcast program. During the webinar, Ms. Kulkarni explained how employees can protect themselves from workplace discrimination by taking control and learning their legal rights in the workplace. View the episode here.

In Case You Missed It


Patients Raise Concerns with New Cigna Policy that Pays Patients to Switch Meds
 
Patient groups and practitioners have raised concerns about a new Cigna policy that offers a $500 pre-paid medical debit card to patients if they switch from a biologic product for multiple rheumatic diseases to a Cigna-preferred drug. The policy follows Cigna’s removal of the drug from its preferred drug list and encourages patients to switch to drugs for nonmedical reasons. Patients and practitioners have called the $500 debit card coercive during the economic uncertainty caused by the COVID-19 pandemic and expressed concerns that it could result in nonmedical switching. Read more here and here.

Contact Us
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