pharmacist gag clauses legislation

Congress Said Yes! to Transparency at the Pharmacy Counter

In a strong show of bipartisanship, the U.S. House of Representatives and U.S. Senate overwhelmingly passed two pieces of legislation at the end of September that would make it easier for pharmacists to tell patients about their payment options at the pharmacy counter.

Beginning last spring, the Arthritis Foundation led the charge by building support in Congress and among other patient and provider organizations about the importance of this legislation. The bills moved quickly through the legislative process thanks to the strength of Arthritis Foundation Advocates and Ambassadors, who called on their members of Congress to vote in favor of the legislation by sharing their stories.

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100 advocacy state victories

100 State Advocacy Victories….and Counting!

The Arthritis Foundation reached a milestone in September, securing our 100th state legislative victory since 2014! Congratulations Advocates!! All of these victories were made possible due to all of you!

Our victories occurred in 47 states plus Washington, DC, impacting more than 50 million people with doctor-diagnosed arthritis, and have focused on many patient access to care issues like:

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open enrollment take care

TAKE CARE: Advocacy Blog Series – Rock and Enroll With Us This Open Enrollment Season

It’s that time of year again! Leaves are changing, seasons are shifting and it’s officially time to kick off all things open enrollment. Learn the ins and outs of open enrollment so you have the tools to find the plan that works best for you.

Start here with our 10 Tips for Managing Your Care Costs video – it’s  quick and easy, and in less than five minutes you’ll be 10 tips closer to mastering your health coverage.

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association health plans

TAKE CARE: Advocacy Blog Series – Association Health Plans

We are continuing our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you’re just now tuning into this series, check out our previous advocacy blog posts here. In August, we kicked off a focus on health insurance benefits as we approach open enrollment this fall. This week, we take a closer look at association health plans.

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stephanie kwiecien

Ambassador Spotlight – Stephanie Kwiecien

Advocating for the arthritis community, says 27-year-old Stephanie Kwiecien, has restored the voice that bullying shut down.

“Advocacy is really important to me because it gave me back the voice I thought I’d lost,” says Kwiecien, who was diagnosed with juvenile rheumatoid arthritis (now known as juvenile idiopathic arthritis) when she was 18 months old. During her elementary and middle school years, Kwiecien’s peers were unfazed by her condition and her teachers were understanding. But high school was different.

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minnesota step therapy advocacy

MN Governor Dayton Signs Legislation for Step Therapy Guardrails

On May 19, Minnesota Gov. Mark Dayton signed HB 3196 into law! Step therapy legislation gives physicians a clear path toward getting their patients the medications they need.

Having access to affordable, effective and specialized medication is critical for the 54 million Americans living with doctor-diagnosed arthritis nationwide, including over 900,000 in Minnesota. The Arthritis Foundation thanks the bill’s sponsors and Gov. Dayton for helping provide these patient protections to Minnesotans.

Step Therapy is a practice used by insurers that requires people with arthritis to try lower-cost medications before allowing more expensive treatments, despite a physician’s recommendation.

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short term health plans

TAKE CARE: Advocacy Blog Series

Short-Term Health Plans

We are continuing our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you’re now just tuning into this series, check out previous advocacy blog posts here. Our last take care blog kicked off a focus on health insurance benefits and open enrollment. Today we explore short-term health plans, a type of insurance that has been on the market for some time but is receiving attention due to new actions taken by the administration. Read on to learn about these plans and why they are an unsatisfactory option for people with arthritis.

What are short-term health plans?

Short-term health plans are not new. As the name suggests, these plans are meant to fill in temporary gaps in health coverage. For example, if an individual is in between jobs or needs coverage outside of the traditional open enrollment period, short-term plans are available to purchase for up to three months from insurers and brokers.

Why are short-term plans in the news?

Earlier this month, the federal Departments of Labor, Treasury, and Health and Human Services finalized a regulation that loosens and expands the availability of short-term plans. Despite over 98 percent of health care stakeholders strongly opposing this action, the administration decided to move forward with its proposal.

What is changing with short-term health plans?

Beginning in October, the new regulation permits short-term plans to be sold for 12 months and renewed by an individual for up to 3 years. This is a change from current rules, which do not allow short-term plans to be a substitute for comprehensive coverage. Today, they are limited to a duration of 3 months and are not renewable health policies.

Are short-term health plans different than individual market health plans?

Yes, short-term health plans are separate from plans offered on the health insurance exchanges because they do not need to comply with important patient protections enacted under the Affordable Care Act. You will not find these plans on healthcare.gov, for example. Since short-term plans are not considered comprehensive coverage, the new regulation means insurers and brokers can more widely sell short-term plans that:

  • Deny enrollment based on age, gender, health status, or other factors that might suggest an individual’s future use of health care services
  • Exclude coverage for pre-existing conditions
  • Exclude any or all of the essential health benefits like prescription drug coverage, emergency care, or other provider services
  • Apply annual or lifetime dollar limits on coverage
  • Increase patient out-of-pocket maximums above limits imposed by current law
  • Impose more stringent network adequacy requirements

What kind of issues would someone with arthritis face if they enrolled in a short-term health plan?

Short-term plans are not ideal for people with arthritis since they can deny coverage for people with pre-existing conditions. The plans are also medically underwritten, meaning you would be asked to fill out a medical history; in turn, this is used to approve or deny your enrollment. The Affordable Care Act prohibited this behavior for plans offered on the individual market. However, because short-term plans are not considered comprehensive health coverage, they do not need to comply with this rule.

Do short-term policies need to disclose anything specific to consumers?

Yes, they must include clear language stating these plans may not work best for people with pre-existing conditions like arthritis. Be on the lookout for disclosure language that:

  • Urges you to carefully check the policy for exclusions or limitations regarding coverage of pre-existing conditions, or specific health benefits like prescription drugs
  • Warns a loss of short-term plan coverage means you may have to wait until the next open enrollment period before enrolling in health insurance again

For any health plan, it is always good practice to carefully review the terms and conditions to understand the scope of benefits and potential out-of-pocket costs you may incur. 

Is there anything else I should be aware of about short-term health plans during open enrollment?

Short-term health plans often misrepresent health coverage and benefits; these plans also have a history of fraud. In addition, you should know that since these health plans are temporary and do not offer comprehensive coverage, premiums are significantly cheaper than insurance found on healthcare.gov. While lower premiums might sound attractive, if you are unexpectedly diagnosed with a chronic disease like arthritis, your plan may not offer coverage for services like prescription drugs or emergency room visits to help you manage your health – and failure to disclose a medical condition up front could also result in an insurer rescinding the insurance policy, leaving you without any health care coverage at all.

What resources are available from the Arthritis Foundation?

In the coming months the Arthritis Foundation will be raising awareness about the open enrollment period, but you can get started with our Your Coverage, Your Care toolkit. It’s a great resource to help you understand your insurance options, the claims process, and tips to overcome barriers. Additionally, if you have any questions about your health care, we have licensed clinical social workers on staff that can talk with you 24 hours a day for your convenience. You can reach the Arthritis Foundation Helpline at 1-844-HELP (4357).

If you’d like to stay informed of federal and state-based health care issues, consider signing up to be an Advocate. Becoming a part of our Advocacy grassroots network is an easy way to get involved and stay informed.

Related Resources:

Open Enrollment

TAKE CARE: Advocacy Blog Series

It’s Never Too Early to Think About Open Enrollment

We are continuing our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you are just now tuning into this series, check out our previous blog posts on accumulator adjustment programs, pharmacist gag orders, President Trump’s drug pricing blueprint, drug rebates, premium increases, and an update on the Affordable Care Act.

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ambassador spotlight maya miserlain

Junior Ambassador Spotlight – Maya Miserlian

By Maya Miserlian

My name is Maya Miserlian, I’m 15 years old, and I am one of 300,000 children in the US with juvenile arthritis (JA).

At the age of 11 I was diagnosed with Chronic Recurrent Multifocal Osteomyelitis (CRMO), a rare bone disease that is one of the many diseases included in the definition of arthritis umbrella.  My diagnosis came after over a year of being told my aching bones were just ‘growing pains’. CRMO affects one in every million people, which has left me feeling alone in the past, because I did not know anyone else with my diagnosis. In the past year I was introduced to the Arthritis Foundation, which has played a big role in my journey with CRMO. I advocate for arthritis as a Junior Ambassador for the Foundation, which has allowed me to take control of my disease and advocate for myself and others with JA. I consider myself lucky – because I live near my specialist and was able to get on medication that works, I reached remission only three years after my diagnosis. However, easy access to a specialist is not a reality for most people.

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affordable care act update

TAKE CARE: Advocacy Blog Series

Update on the Affordable Care Act

We are continuing our advocacy blog series meant to help you take care when it comes to important arthritis health care and coverage issues. If you are just now tuning into this series, check out our previous blog posts on accumulator adjustment programs, pharmacist gag orders, President Trump’s drug pricing blueprint, drug rebates, and premium increases.

This week, we break down a recent legal challenge to the Affordable Care Act (ACA). A court case was recently thrown into the spotlight as a result of the administration’s decision to file a brief essentially arguing that federal courts should find the ACA’s protection for people with pre-existing conditions unconstitutional. Read on to learn more.

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