Pennsylvania's Representative Vereb has introduced a House Bill regarding requirements for insurers relating to prescription drug coverage. This crucial bill was referred to the Insurance Committee, and has the potential to make specialty drugs that can treat MS much more affordable, therefore, more accessible, to thousands of people across the state.
Basically, when it comes to prescription drugs, as the prices rise, other states have experienced insurers creating cost-sharing methods known as “prescription drug specialty tiers.” These insurers usually use a three-tiered drug structure to provide fixed cost benefits to their insureds, based on three categories: generic, name-brand preferred, and brand-name non-preferred. As the tier levels increase, so do the prescription costs.
Medications to treat MS, however, fall into a specialty fourth (most costly) tier, where individuals are required to pay a co-insurance of anywhere from 20-35% of the drug cost. This places a significant financial burden on the insured individual and can discourage adherence to taking the medication as prescribed. The Pennsylvania House Bill on Tier Four issues (No. 1609) calls this “a structure where those who are sickest pay more, and those who are healthy pay less, thus, the creation of specialty tiers is a discriminatory practice.”
This Pennsylvania House Bill is the first bill of its kind to be introduced in Pennsylvania. Prior to this state-level bill, all efforts to address this practice were made on a national level.
Most recently, in 2009, the National MS Society, along with other like-minded organizations, collaborated with U.S. Senator John D. Rockefeller (D-WV) to introduce the Affordable Access to Prescription Medications Act (S. 1630). Its efforts were to reform prescription drug coverage at a national level, through methods such as establishing monthly caps on out-of-pocket costs for prescriptions, lowering co-payments for up to 10% of Americans with the highest prescription costs, and amending the process through which individuals can request an exception for specialty tier drug coverage.
However, that bill was never passed, and is considered “dead” in the current session of the U.S. Congress.
House Bill 1609 introduced the issue at a state level. Like the National bill S. 1630, the Pennsylvania bill aims to reduce costs for insureds by instituting co-pay and payment restrictions, making insurers take the bulk of financial responsibility for costly medications. Limiting extreme financial burdens on patients will increase accessibility to much-needed specialty drugs to fight MS.
A hearing will be held when the House reconvenes in September. Hearings play a significant role in the passing of a bill such as this one. Their purpose is to gather and present more information to representatives so they can develop an informed position on the issue. Testimonies by organizations such as the MS Society and individuals afflicted with MS will be especially helpful; they validate the bill by proving to representatives that the issue does affect real people, and there are organizations who stand behind it.
Testimony from those affected by Tier four prices will be essential to pass such a bill. Utilizing real stories is the most effective way to move this key piece of legislation. These stories will provide representatives with real accounts of how many people are affected by expensive drug prices and how this bill could change that. Access to prescription drugs is critical for those with MS; if you or someone you know has had cost-related issues getting the prescription drugs they need, please share your story.
Whether you come to Harrisburg to testify in person, or write or tell your story to staff of the National MS Society who can testify on your behalf, you can greatly impact the decision. You can change legislation and make MS treating prescription drugs more affordable to those who need them.
For more information, contact Jennifer Strayer, Public Policy Manager for the National MS Soceity at: (717) 586-8505 or Jennifer.Strayer@nmss.org
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