In the News

• The Daily Advocate: Cutting out-of-pockets costs

  Patients with chronic, complex conditions such as multiple sclerosis and hemophilia rely on copay assistance programs through drug manufacturers, charities, and churches to help cover the costs of their prescription drugs. Recently, many major health insurance providers have implemented discriminatory policies that no longer allow the payments made through copay assistance programs to count toward a patient’s deductible.

  READ MORE

• Modern Healthcare: Virginia and West Virginia are first states to ban copay accumulators

  Virginia and West Virginia became the first states to ban an insurer practice that prevents drug manufacturer coupons and copay assistance from counting against a plan's deductible or out-of-pocket limit, and patient advocates believe more states are going to follow suit.

  READ MORE

• Observer: Using Prescription Coupons Might Be Raising Your Insurance Copay

  The total value of the coupon is applied evenly throughout the benefit year but does not count against a patient’s cost-sharing obligations. The result, as with accumulators, is that PBMs reduce their financial liability by leveraging the value of the coupon and the beneficiary cost-sharing amounts. In short, maximizers raise copays for patients using coupons.

  READ MORE

• NOLA.com: Aetna director admits to never examining patient medical records when approving, denying coverage

  The California Insurance Commissioner launched an investigation into health insurance provider Aetna after one of its former medical directors admitted under oath that he had never looked at patient records when deciding whether to approve or reject coverage, according to CNN.

  READ MORE

• FOX 8: Drug consumers seek relief as PBM's make money hand over fist

  "It's crazy, it's distressing," Shoemaker says, "the amount of money you pay for insurance. I pay between $600 and $700 a month for a premium because I'm a single person, I don't have a company, you know, getting any discounts with big group insurance policies. So, it's very distressing - you're already spending a ton of money on insurance, but you still have to pay for, you know, all of the extra."

  READ MORE

• The Times: Analysis: Hunt is on in to cut Louisiana costs without pain

  Even after lawmakers approved more $1.2 billion in taxes for next year in a special legislative session, Louisiana is short $750 million of what is needed to continue all existing programs and services in the budget year that begins July 1. Edwards, a Democrat, is warning of deep and harmful cuts to colleges, health care services and many other programs.

  READ MORE

• The Hill: UnitedHealth to Congress: Let cancer patients eat gauze

  Ask patients where these actions are necessary and you’re likely to hear about the detested practice of health plans requiring patients to use medication after medication until their insurance company agrees to pay for the drug actually prescribed by their doctor. Insurers have a benign term for this: “step therapy.” But cancer advocacy organizations call it something else: “fail first.”

  READ MORE

• New York Times: Study Finds H.I.V. Drugs Priced Out of Reach

  Drugs to treat H.I.V. and AIDS are being priced out of reach for many patients enrolled in insurance plans through the new health care exchanges, despite warnings that such practices are illegal under the Obama administration’s health care law, according to a new analysis by Harvard researchers.

  READ MORE