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Aimed Monthly, Volume 1, Issue 9

Welcome to Volume 1, Issue 9 of Aimed Monthly! In this issue, we are pleased to announce the release of our 2018 Annual Report, and we are eager to share with you a comment that we submitted to ICER, nonmedical switching complaints that we sent to a health plan in Michigan and the Cleveland Clinic, and updates from the Exocrine Pancreatic Insufficiency Coalition (EPIC).


EPIC Advocacy Efforts
On July 22, 2019, the Exocrine Pancreatic Insufficiency Coalition (EPIC) sent a letter to CVS Health in response to the company’s decision to exclude coverage for a pancreatic enzyme replacement therapy (PERT) in the middle of the plan year. Aimed Alliance has received a response from CVS Health’s Chief Medical Officer, who explained that CVS Health will now allow pediatric patients to remain on their current medication. We are pleased with these results. EPIC will continue to discuss this issue with CVS Health and will request that all patients with exocrine pancreatic insufficiency (EPI) be allowed to stay on their current medication.
Apples to Oranges
On August 19, 2019, Aimed Alliance submitted a comment to the Institute for Clinical and Economic Review (ICER) regarding the organization’s comparative effectiveness review of icosapent ethyl and rivoroxaban. Aimed Alliance’s comment cautioned against comparing these two treatments because they have different mechanisms of action in the body and have different uses: icosapent ethyl is a supplement intended for adults to reduce triglyceride levels for adults with severe hypertriglyceridemia while rivaroxaban is a medication used to reduce the risk of stroke and systemic embolism for patients with a nonvalvular atrial defibrillation. Additionally, the letter requested that ICER consider the patient’s perspective, incorporate additional data from relevant studies, and imploring the organization not to use the Quality Adjusted Life Years (QALY) metric when determining comparative effectiveness. Learn more about our comment to ICER.
Systematic Switches at the Cleveland Clinic 
On August 26, 2019, Aimed Alliance sent a letter to the Cleveland Clinic, requesting that the health system end its nonmedical switching practices and to allow stable patients to remain on their current medication. This letter is a follow-up from an initial letter that Aimed Alliance sent in December of 2018. It also highlights a report published in July that studied nonmedical switching practices among health systems in Ohio. We have not yet received a response from the Cleveland Clinic as a result of this advocacy campaign.
Beware of "Bad Drug" Ads 
On August 29, 2019, Aimed Alliance published a brochure for consumers to help them understand media advertisements for class action lawsuits that relate to a medication they are currently taking. These advertisements are often developed by law firms seeking additional plaintiffs for class action lawsuits and typically use frightening and disturbing imagery that could persuade a patient to stop taking their medication without first consulting with their doctor. Review our brochure on these advertisements to understand the motivation behind the dangers they present to consumers.
Another Mid-Year Switch in Michigan 
On September 10, 2019, Aimed Alliance sent a group sign-on letter to the Blue Cross Blue Shield of Michigan (BCBSM) health plan in response to the plan’s decision to force stable patients with conditions like rheumatoid arthritis, Crohn’s disease, and psoriasis to switch from their current biologic to a biosimilar treatment. This switch occurred in the middle of the plan year, which prevents patients from enrolling in a different health plan that would provide more favorable coverage of their current treatment. Several organizations signed onto this letter, including the American Autoimmune and Related Diseases Association (AARDA), the Coalition of State Rheumatology Organizations (CSRO), the Michigan Rheumatism Society, and the National Infusion Center Association (NICA). Review the letter to learn more.
Aimed Alliance Annual Report 
On September 12, 2019, Aimed Alliance released its first Annual Report, which provides an overview of the organization’s progress in 2018. You can review our Annual Report to learn more about the organization, its staff, and projects that we completed during the year.


  • 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.
  • Biosimilars
    • On Friday, October 25, 2019, Aimed Alliance Counsel Stacey L. Worthy, Esq. will be speaking at HealthyWomen’s Biosimilars & Women’s Health Forum at the National Union Building in Washington, DC. This event will bring together patient advocates, researchers, and clinicians, and industry and government representatives. Ms. Worthy will be discussing current federal regulations regarding biosimilars. To register, click here.
  • ICER
    • Aimed Alliance’s Policy Advisor, Taylor Kelly, JD, will be delivering oral comments to ICER regarding its comparative effectiveness review of cardiovascular treatments in St. Louis, MO, on Thursday, September 26.
  • NFWL
    • Aimed Alliance Counsel Stacey L. Worthy, Esq. will be presenting on emerging health care topics at the National Foundation of Women Legislators’ Annual Conference in San Antonio, TX on November 19, 2019.

Where We've Been

  • State Society Advocacy Conference
    • Aimed Alliance Staff Attorney John A. Wylam, Esq. attended the State Society Advocacy Conference hosted by the Coalition of State Rheumatology Organizations (CSRO) from September 13-14, 2019.
  • Congressional Awards Dinner
    • Aimed Alliance Counsel Stacey L. Worthy, Esq. attended the Alliance for Aging Research’s Bipartisan Congressional Awards Dinner on September 17, 2019.

In Case You Missed It

  • Maine Bureau of Insurance Report
    • In July, the Maine Bureau of Insurance published a quarterly report that analyzes mid-year formulary changes made by health plans that operate in the state. This report highlights how 329 medications were subject to formulary changes in the first quarter of the year. Nearly one-fourth of those formulary changes were to remove a treatment from the formulary, which can increase costs for patients. Roughly half of the formulary changes were done to add prior authorization, move the treatment to a higher cost-sharing tier, add a quantity limit, or add step therapy. Due to these mid-year formulary changes, the Bureau of Insurance identified 41 patients who would be responsible for higher costs for the same medication, and 250 patients who would be responsible for the full cost of the medication due to it being removed from the formulary. For those patients, the only affordable option could be to switch to a different treatment.
  • U.S. Census Bureau Report
    • On September 10, 2019, the U.S. Census Bureau published a report that analyzed health insurance coverage in the United States for 2018. This report revealed that the number of uninsured Americans rose to 8.5 percent last year, with most coverage losses stemming from state Medicaid programs. Read more.
  • Urban Institute Report
    • On September 11, 2019, the Urban Institute published a report titled Despite Recent Improvement, One in Six Children Lived in a Family with Problems Paying Medical Bills in 2017. This report pulls from data collected through the National Health Interview Survey and examines how the share of children in families who had problems paying medical bills changed between 2013 and 2017. Additionally, the report discusses how difficulty paying medical bills varies across coverage and plan types. This report found that “23.4 percent of children with family incomes at or below 250 percent of FPL were in families that had trouble paying medical bills,” which is much higher than the 10.9 percent of children who were in families above 250 percent of FPL who had problems paying medical bills. Review the report to learn more.
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