Archives     Advertise     Editorial Calendar     Subscribe     Contact Us    



Tennessee Patient Stability Coalition Applauds Proposed Rx Benefits Legislation


 

Feb. 9, 2017 - An unexpected denial letter in the mail, a surprise bill at the pharmacy counter: many Tennessee consumers are discovering the prescription coverage benefits they signed up for are not the benefits they actually receive. It's a problem new legislation aims to fix, according to the Tennessee Patient Stability Coalition, a coalition of 17 leading patient and provider groups. The coalition today applauded a bill that would require commercial health plans honor the terms of their prescription coverage plans for the duration of the contract year. The legislation, known as the "Reliable Coverage Act" (SB 991/HB 960), is designed to protect consumers by preventing prescription coverage reductions outside of the open enrollment period.

"As both a physician and a consumer, I am proud to stand behind a common-sense bill that asks insurers to follow through on the benefits they offer during open enrollment," said Sen. Mark Green, MD (R-Clarksville), who, along with Rep. Bryan Terry, MD (R-Murfreesboro), is sponsoring the legislation. "If insurers advertise and sell a certain level of prescription coverage, Tennesseans should be able to rely on that coverage for the remainder of the contract year."

"Aside from consumer protection and fairness, the other big issue is that these plan changes can be unsafe," said Terry, who is also a physician. "If you're living with a serious health condition and your insurer changes your prescription benefits, then you can be switched to an entirely different drug with different side effects and degrees of effectiveness. I have seen it happen. This has a real-life impact on patients which can lead to exacerbating one's condition or even hospitalization."

Insurers may reduce prescription coverage after open enrollment in a variety of ways, including removing a medication from coverage altogether, increasing out-of-pocket costs for a medication or placing additional restrictions around access (such as requiring prior authorization). The practice of reducing drug coverage midyear has become known as "non-medical switching," because it often forces patients to switch to an insurer-preferred medication, regardless of the potentially negative impact on their health.

"Arbitrarily forcing patients off a medication with no advanced warning and for no medical reason is both unfair and dangerous," said Katherine Moffat, executive director of the Tennessee Academy of Physician Assistants, which is a member of the Tennessee Patient Stability Coalition. "Patients and their clinicians may work together for years, trying multiple medications, before they find one that works. These midyear coverage reductions can upend a patient's hard-won stability, resulting in otherwise-avoidable symptoms, side effects and even relapse. Insurers should not be able to interfere with treatment in such a significant, potentially harmful way."

Proponents of the bill point to studies that show non-medical switching may result in poorer health outcomes and, as a result, may actually increase overall health care costs. For example, one study found that patients with epilepsy who were switched off their original medication experienced more breakthrough seizures and sought more inpatient and emergency care than those were not switched. An analysis of patients with rheumatoid arthritis, Crohn's, psoriasis and other autoimmune conditions who were switched found they incurred 37 percent higher medical costs than normal.

"We are hearing stories from consumers across Tennessee who are stable on a medication for years and then are suddenly forced off," said Jeff Fladen, executive director of the National Alliance on Mental Illness-Tennessee, also a coalition member. "With mental illness, treatment often looks more like an art than a science as the treatment provider tries various medications. It can take years to find the correct medications that enable an individual to keep symptoms at bay. People with mental illness may have to miss work as they struggle to find a new medication that works, which means lost productivity or even lost jobs and economic self-sufficiency. Then there's the emotional impact of unexpectedly losing access to the drug you relied on. Simply put, it's wrong."

While the bill would prohibit insurers from reducing prescription coverage during the plan year, it would not impede insurers from adding medications to their formularies, including new generic products, or making changes necessary for safety reasons that are outlined by the U.S. Food and Drug Administration. It also would not affect or prohibit generic substitution.

"The Reliable Coverage Act is a straightforward piece of legislation that will protect consumers from unnecessary, unfair reductions to their health plans," said Shaina Smith, director of State Advocacy & Alliance Development for the U.S. Pain Foundation, which leads the Tennessee Patient Stability Coalition. "We thank Representative Bryan Terry and Senator Mark Green for realizing the lack of consumer protections in the state of Tennessee and putting together a thoughtful, bipartisan solution."

A survey conducted by the coalition shows that unforeseen insurance coverage changes are a major problem in Tennessee. According to the survey, 58 percent of Tennesseans living with chronic illness said their insurance company made coverage changes during the plan year that reduced coverage of their prescription medication, and 67 percent of these were forced to switch treatments as a result. Of these:

  • 66 percent reported that, after switching, their medication was less effective;
  • 89 percent reported that the side effects were worse on the insurer-preferred drug;
  • 44 percent said they never received any notice from their insurer detailing their plan's formulary of the changes being made to it;
  • 99 percent support legislation that would prohibit insurance companies from financially pressuring patients to switch their prescribed medication for non-medical reasons.

About the Tennessee Patient Stability Coalition

The Tennessee Patient Stability Coalition, made up of 17 patient and clinician groups, is dedicated to protecting consumers from the unfair insurance practice known as "non-medical switching," which occurs when insurers reduce coverage of medications after the consumer has already signed on to the original plan terms. Coalition members include: AIMED Alliance, Alliance for Patient Access, Arthritis Foundation, Coalition of State Rheumatology Organizations, Global Healthy Living Foundation, Lupus and Allied Diseases Association, National Alliance on Mental Illness-Davidson County, National Alliance on Mental Illness-Tennessee, Patients Rising, The Arc of Tennessee, TN AIDs Action Network, TN Dermatology Society, TN Disability Coalition, TN Nurses Association, TN Physician Assistants, TN Rheumatology Society and the U.S. Pain Foundation, which leads the coalition. For more information, visit:https://www.facebook.com/pg/TNPatientStabilityCoalition/.

 
Share:

Related Articles:


Recent Articles

Senate HELP Committee Hearing on Gene Editing Technology

On Nov. 14, the Senate health committee held a hearing on the gene editing method CRISPR to learn more about the technology from expert witnesses, which included Dr. Matthew Porteus, associate professor of Pediatrics at Stanford University; Katrine Bosley, CEO and president of Editas Medicine; and Dr. Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics at Johns Hopkins School of Public Health.

Read More

Nashville Health Care Council Hosts Panel Discussion on Pharma/Provider Collaborations in Health Care

On Nov. 13, the Nashville Health Care Council hosted a panel discussion on collaborations between the pharmaceutical and healthcare provider sectors and how those collaborations can drive change in healthcare.

Read More

Tennessee Health Care Hall of Fame Class of 2017

Six healthcare luminaries were recently inducted into the Tennessee Health Care Hall of Fame.

Read More

NMGMA 10 Minute Takeaway

Nashville Medical News recently had the opportunity to chat with new NMGMA president Joy Testa.

Read More

Tennessee Joins Medical Licensing Compact

A new Tennessee law will make it easier for area physicians to practice across state lines beginning in 2019 as part of the Interstate Medical Licensure Compact.

Read More

A Plan to Address COPD

COPD is the third leading cause of death in America, yet it lags behind many other conditions in terms of research dollars and coordinated federal response ... but that seems to be changing.

Read More

Surgical Innovations

Two new procedures recently made their debut in Middle Tennessee offering new treatment options for coronary bifurcation lesions and lumbar fusion.

Read More

Don't fear the FBAR

If you are a taxpayer with offshore financial accounts, you could be in trouble with the IRS and not even know it.

Read More

HoneyCo Homes: Using Smart Technology to Help Seniors Age in Place

A Nashville startup is using technology to help seniors age in place while providing peace of mind to loved ones and actionable data to caregivers.

Read More

A Better Continuum Means Better Care

As the U.S. population ages, new partnerships along the continuum of care are necessary to achieve optimal outcomes for patients.

Read More

Email Print
 
 

 

 


Tags:
None
Powered by Bondware
News Publishing Software

The browser you are using is outdated!

You may not be getting all you can out of your browsing experience
and may be open to security risks!

Consider upgrading to the latest version of your browser or choose on below: