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State Legislative Landscape: Highlights of Healthcare Bills

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Published on June 19, 2019

Just in the past month a number of new healthcare laws have been enacted at the state level. How will they impact cancer patients’ access to care? Tune in to hear John Wylam, from Aimed Alliance, provide a brief overview of state-level legislative activity and explain how these bills will either protect patients or make access and coverage more difficult. 

This is an Aimed Alliance program produced by Patient Power. We thank AbbVie Inc. for their support. These organizations have no editorial control. It is produced solely by Patient Power.

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Transcript | State Legislative Landscape: Highlights of Healthcare Bills

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:        

Let’s talk about the states. So, some states are working hard to provide greater access for patients and patients like me, cancer patient. And in other cases, they’re making more difficult. Maybe you could describe that. 

John Wylam:             

Yeah, so we’ve seen a lot of activity in the states this year, and many are wrapping up their legislative sessions. So, in the past month or two, we’ve seen a number of new laws enacted. Here at Aimed Alliance, we track legislation on a range of access-to-care topics including step therapy, prior authorization, non-medical switching, and co-pay accumulators. I can give you a brief overview of where things stand on these topics. On step therapy, new laws have recently been enacted in Georgia, Oklahoma and Virginia. 

One additional bill has passed the Washington legislature, and it’s awaiting the governor’s signature. So, these new laws will place stronger guardrails on step therapy protocols to protect patients. Without laws like these, patients will not able to override a step therapy protocol, even if the medication they need is medically necessary. On prior authorization, new laws were enacted in Kentucky, Utah, and New Mexico in March. These new laws will more strictly regulate when prior authorizations will be used and how insurers will handle prior authorization requests. 

So, great news to share is that Arizona, Virginia, and West Virginia have become the first states to regulate co-pay accumulator programs. So, co-pay accumulators threaten patient access to care by preventing cost sharing amounts from being counted towards their deductible and their maximum out-of-pocket costs when a third party pays the cost sharing amount on their behalf. And so, what this does is it slows the pace at which enrollees can complete the deductible phase of their coverage, and it delays their entry into the coverage phase. So, the laws that are recently enacted in these states will completely prevent that situation from occurring.

Andrew Schorr:        

Right. Let me just comment on that for a second, John. Your colleague Stacey Worthy and I have talked about that, and we have another program specifically on co-pay accumulators. But the way I see it as a patient is the insurance companies kind of moving the goal post on you, where you thought that your out-of-pocket cap for medication, for example, or healthcare coverage was X and you said, “Oh, I’ll afford that if I need to a year.” And then they say, “Well, if you’re getting assistance from a drug company’s co-pay guard or a foundation that’s helping you with your co-pay, it doesn’t count towards that.” Sounds terrible. 

John Wylam:             

Yeah, and what’s particularly difficult about those is that the programs aren’t really communicated to enrollees very well, so people are really blindsided when people find out they may have paid $0 towards their deductible when they thought they’d already completed it, and that can stick them with unavoidable health costs.  

Andrew Schorr:        

Okay, anything else at the state level that you want our viewers to know about?  

John Wylam:                           

So, those are the highlights that I wanted to provide. I know that I mentioned non-medical switching earlier, but I’m unfortunately unable to share any progress on that this year, so…hopefully next year.

Andrew Schorr:        

Okay. Non-medical switching refers to the insurance companies saying, “You gotta do this” instead of what the doctor is recommending, right? 

John Wylam:             

It’s similar to that. It’s more like, when you’re enrolled in a health plan, and when you enrolled in that health plan, you knew that a certain drug was gonna be covered on a certain tier. And then, you get halfway through the year and suddenly your insurer decides, “We’re changing the coverage status of this drug. We’re no longer gonna cover it.” So, what happens is it’s a mid-year switch of your formulary at a time when you’re unable to go find other coverage, so for some people, they could be completely cut off of the medication that they’re stable on. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.