Category Archives: Uncategorized

How to Change Unreasonable Insurance Rules

Tricia’s story is like many others trying to make arthritis coverage more affordable

My name is Tricia Mershon, and I live with my family in Corona, California. At the age of 3, my daughter, Rachel, was found to have a dysfunctional immune system. Her tiny body failed to mount a response to infection, and various disease specialists were able to document the phenomenon but unable to pinpoint a cause.

Just before ninth grade, Rachel’s fingers curved into a funny “s” shape and looked different than those of anyone else. When she began having pain in her feet, knees and hips, which sometimes made walking difficult, Rachel was promptly referred to rheumatology, and we found the real culprit. At 14, Rachel was diagnosed with juvenile idiopathic (rheumatoid) arthritis. She began aggressive treatment to halt the progression of this insidious disease. Continue reading How to Change Unreasonable Insurance Rules

Out-of-Pocket Costs: An Out-of-this-World Problem

Let’s face it: out-of-pocket costs for patients with chronic diseases like arthritis are consuming an ever-growing share of household spending. Lowering drug prices has been a central priority of Congress and the Administration this year, and while a lot of attention is paid to drug companies and insurers, the impact on the patient often gets lost. There may be a lot of chatter about list prices, rebates, and other technical terms, but at the end of the day the health care price that matters most to patients is the one coming out of their own pocket. Continue reading Out-of-Pocket Costs: An Out-of-this-World Problem

How Gaye Jacques Is Making Arthritis a Priority in the 2020 Election

New Hampshire is one of a handful of states with a special fifth season — Primary Candidate Visit Season. Gaye Jacques decided to take advantage of it by trying to meet as many of the Democrat primary candidates as she possibly could, bringing their attention to the barriers to care people with arthritis face every day. Continue reading How Gaye Jacques Is Making Arthritis a Priority in the 2020 Election

New Step Therapy Reform Law in Oklahoma

The Arthritis Foundation is happy to announce that the Oklahoma legislature passed a new law this month that will protect Oklahomans who are living with arthritis.

The new OK law will reform step therapy. Also known as “fail first,” step therapy is a process that forces patients to try and fail drugs that insurance companies choose before the patient gets to use the medicine their doctor originally prescribed. This may occur even if you are already taking a medication and doing well on it.

Oklahoma Junior Ambassador and AFJROTC member, Brianna Sommers, attended the Arthritis Foundation’s February Legislative Day and was instrumental in passing the step therapy reform bill.

“We did not know at the time of my first diagnosis that step therapy would be the cause of the majority of my pain.

“I was diagnosed with rheumatoid arthritis and fibromyalgia at age 9. I went through years of my doctors having to make me try and fail multiple drugs, due to step therapy practices.

“Doctors are the medical experts and allowing an insurance company to control what medications a physician is able to prescribe is life-threatening. When I heard about the OK step therapy reform bill, I knew I needed to get involved. I needed to not only do it for myself, but I also needed to help others like me.

“I was a part of a group of kids who had cancer, disorders and other life-threatening illnesses, and I thought about how many of those kids were being asked to take unnecessary medications and procedures due to step therapy. When you are dealing with children, sometimes time is of the essence. I’m just glad I could make a difference.” 
–Brianna Sommers, Junior Ambassador from Choctaw

Senate Bill 509 places limits on step therapy and helps get the right medicine to patients faster. The new law was introduced by Sen. Dave Rader and Reps. Cyndi Munson and Jon Echols, and we are so appreciative of their leadership. This is a major victory for all Oklahoma Advocates. Let’s keep up our momentum!

Help us raise awareness about the importance of step therapy reform at the federal level. Ask your member of Congress to support the Safe Step Act. Take action today!

For more information about how to get involved with advocacy in Oklahoma, please contact Kristen Crawford at kcrawford@arthritis.org

 

2019 Advocacy Summit – A Busy First Day Readies Advocates for a Day on Capitol Hill

2019 Advocacy Summit – A Busy First Day Readies Advocates for a Day on Capitol Hill

Yesterday, more than 300 Advocates from all parts of the United States came together in Washington, DC, filled with fire as they get ready to voice their personal stories to make real and meaningful changes for the arthritis community.

The Arthritis Foundation’s 2019 Advocacy Summit kicked off on Monday, March 11, 2019, with an exciting welcome by Foundation President and CEO Ann M. Palmer. The day included motivational and educational breakout sessions where Advocates learned about key legislative asks to support top issues affecting the arthritis community’s access to affordable care. They also learned some important tips and tricks for their Capitol Hill meetings and had the opportunity to participate in a Live Yes! Connect Group demonstration.

The intensive day of training and information concluded with the Excellence in Advocacy Awards Dinner. Seventeen-year-old Ethan Berkovitz from Solon, Ohio, was awarded the Emerging Leader in Advocacy Award for his continued efforts to raise awareness of the disease by actively advocating on Capitol Hill and the Ohio Statehouse, as well as being the go-to team captain for the Walk to Cure Arthritis and Jingle Bell Run.

 

Karen Anderson of Santa Barbara, California, was awarded the Edward M. Kennedy Advocacy Leadership Award for her many years of advocacy on behalf of the Arthritis Foundation. Karen is attending her 11th Advocacy Summit and has been a Platinum Ambassador since its inception. She began volunteering for the Arthritis Foundation after her daughter, Kristin, was diagnosed with systemic scleroderma, one of the over 100 forms of arthritis, at the age of 15. Karen’s introduction to the Foundation was at a JA Conference, and since then she has been a passionate volunteer at the local, regional and national levels. She has served as Walk to Cure Arthritis chair, advisory board chair, regional public policy and advocacy chair and as a member of the national public policy committee.

Representatives Brad Wenstrup (R-OH) and Raul Ruiz, MD (D-CA), received the Advocacy Leadership Award for fighting to reform step therapy requirements nationwide and break down barriers to care for people with arthritis.

A record 70 Platinum Ambassadors were also recognized for going above and beyond the call of duty by accomplishing a challenging list of advocacy needs, all while raising funds to support our efforts to conquer and cure arthritis.

At the end of the day, Advocates were preparing themselves for hundreds of meetings they have in store with members of Congress. During these meetings, legislators will be asked to discuss legislative priorities like reforming burdensome step therapy practices and making access to vital treatments easier and more affordable. They will also be urged to support funding for arthritis research at the Department of Defense and to join the Congressional Arthritis Caucus – a group for members of Congress that serves as a clearinghouse for information regarding arthritis and its devastating toll on our population and economy.

Join us on March 12 at 12:00 p.m. ET to help amplify the impact of our in-person meetings with legislators by participating virtually in our #AdvocateforArthritis social media campaign. Print out this sign and, in one sentence, written large and legibly, tell us why you #AdvocateforArthritis!

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:

drug rebates header

TAKE CARE: Advocacy Blog Series

Drug Rebates 

We’re excited to continue 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, and President Trump’s drug pricing blueprint.

This week we dig in to the world of drug rebates, which are often negotiated between pharmaceutical manufacturers and pharmacy benefit managers (PBMs). Read on to learn more about how drug rebates play a role in the drug supply chain and impact access to medications.

Continue reading TAKE CARE: Advocacy Blog Series