On Thursday, October 12, 2017, the Administration took two actions on health care that could affect coverage for people who have health insurance through the exchanges.
President Trump signed an executive order that opens the door for the expansion of association health plans, which aren’t subject to the same level of patient protections as required by the Affordable Care Act (ACA). Second, the Administration announced the discontinuation of cost-sharing reduction payments, which are payments to health insurers that help reduce out-of-pocket costs for low income people who purchase insurance on the health exchanges.
Read on to learn more about the Administration’s actions and their potential impacts on the arthritis community.
Continue reading Answering Your Questions About the Latest Administration Actions on Health Care
The Senate is expected to open debate today on two bills that repeal and replace the Affordable Care Act. Tell your senator to vote no and work to write a health bill that serves patients!
Not getting health insurance because you have a pre-existing condition.
Thousands upon thousands of dollars in out-of-pocket costs every year with no end in sight.
Fear of reaching your maximum lifetime benefit because you take expensive drugs or had multiple surgeries and hospital stays.
This is what life looked like for many people before the Affordable Care Act (ACA) was passed into law in 2010. While the ACA is far from perfect, it offers critical protections like caps on annual out-of-pocket spending, a ban on lifetime coverage limits, a prohibition on pre-existing conditions exclusions and minimum essential health benefits like prescription drugs and hospitalizations.
Continue reading Senate Health Bills Fall Short for Arthritis Community
From Kerry Wong
Nearly 10 years ago, I began feeling a variety of symptoms that didn’t seem to make much sense. I was exhausted and sore without doing anything strenuous, frequently weak, dizzy and nauseous. I couldn’t sleep.
Continue reading Ambassador Spotlight: Kerry Wong, New York
On June 2, Colorado Governor John Hickenlooper signed Senate Bill 203 (SB 203) into law! This important bill stops insurance plans from requiring patients to go through step therapy for their medication if they previously went through step therapy protocols with their current or former insurer.
Continue reading Colorado Passes Law Restricting Step Therapy!
Exciting news in Texas! On May 23, Governor Greg Abbott signed Senate Bill 680 into law, limiting the use of step therapy. Texas now joins a growing number of states that have enacted laws that regulate the use of step therapy. With over 4 million adults and 24,900 kids with doctor-diagnosed arthritis in Texas, this is a major victory!
Step therapy is used by health insurance providers to control the order and use of prescriptions drugs. A patient could be required to try and fail lower-cost or other drugs selected by their insurance provider before coverage is granted for the drug prescribed by the patient’s treating physician. For patients, this barrier to care prevents timely access to doctor prescribed treatments and can be the difference between full mobility and joint damage.
Continue reading Victory in Texas – Legislation Limits Step Therapy
We applaud Maryland Governor Larry Hogan for joining 28 other states in creating a pathway for the substitution of biologic medications with biosimilars by signing the Pharmacists – Substitution and Dispensing of Biological Products bill into law.
Biologics are life altering drugs for people with arthritis and are very complex products made with living cells. Because of this complexity they are expensive. Biosimilars, are a new class of drugs that are similar to biologics. They have the potential to lower medication costs.
Continue reading Victory for Maryland! Biosimilar Bill Signed by the Governor!
The Iowa arthritis community is celebrating Governor Branstad signing into law House File 233 on May 10, 2017.
The bill, unanimously passed by both chambers, puts limits on an insurance industry protocol known as step therapy which requires patients to try and fail medications identified by the insurance company before agreeing to cover medications prescribed by the treating physician. The bill will increase access to care for arthritis patients by limiting step therapy practices in Iowa.
Continue reading Victory in Iowa! Governor Branstad Signs into Law a Bill to Curb Step Therapy!
Congratulations D.C. Advocates! Because of your efforts, Washington, D.C. Mayor Muriel Bowser signed the Specialty Drug Copayment Limitation Act. In the law, “specialty drug” means a prescription drug that is prescribed for a person with a physical, behavioral, or developmental condition that may have no known cure, is progressive, or can be debilitating or fatal if left untreated or undertreated, such as multiple sclerosis, hepatitis C and rheumatoid arthritis.
Continue reading The Nation’s Capital Caps the Out-of-Pocket Costs of Medications
Families, physicians and patients gathered in Harrisburg, PA on March 28 to learn more about potential legislation that could affect access to care and meet with their legislators to enlist their help. They shared their stories with legislators and asked them to cosponsor the prior authorization bill and the copay cap bill. It was an impactful day of relationship building using personal stories to communicate the urgent need for support and passage of these bills.
Continue reading 35 Attend Capitol Day in Pennsylvania Advocating for Prior Authorization and Copay Cap Bills
Step therapy is a cost saving tactic used by insurers that requires people with arthritis and other potentially debilitating conditions to try and fail lower-cost medications before covering more expensive treatments. In other words, insurance companies oftentimes disregard treating physicians’ knowledge of their patients and related expertise, forcing patients to try cheaper medications, all to save a few dollars.
Continue reading Step Therapy Win in West Virginia!