3 Health Care Policies to Know

7.23.20

The current public health crisis has forced millions of Americans to recognize that access to high-quality health care is vitally important. Without adequate or affordable coverage, a trip to the hospital can cost thousands of dollars. This is a reality that chronic disease patients face everyday, with or without the COVID-19 pandemic.

At the Chronic Disease Coalition, we believe all patients deserve access to quality care. In this week’s blog, we look at several policies that either promote increased access or create challenges for patients across the nation.

  1. Patient Protection and Affordable Care Enhancement Act (H.R. 1425)

In March, the Affordable Care Act (ACA) celebrated its tenth anniversary and the coverage of nearly 22 million Americans. Despite this statistic, the validity of the ACA has been debated by the Trump Administration.

The Patient Protection and Affordable Care Enhancement Act, or H.R. 1425, was introduced to help increase affordability, access to coverage and protect patients from purchasing inadequate health plans. Specifically, the bill will provide subsidies to patients to help afford their care and fund programs that provide information about health plans and a patient’s options.

Learn more about this bill in a recent Health Affairs article.

  1. Louisiana H.B. 263

Earlier this summer Louisiana Governor John Bel Edwards signed a critical piece of step therapy legislation into law. Step therapy is a dangerous practice implemented by health insurers, forcing patients to try and “fail” on a medication(s) before they can access the treatment prescribed by their doctor.

House Bill 263 enacts stronger protections and creates a transparent process for patients to request exemptions from step therapy protocols. It also requires insurers to base step therapy protocols on clinical review criteria and clinical practice guidelines to help mitigate the negative impact these practices could have on a patient’s health.

  1. Medicaid Proposed Rule

On June 19, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that included concerning guidance on copay accumulator programs.

Patients battling chronic disease often require biologics or other specialty medication to treat and manage their condition. To help afford their treatment, a patient may utilize a copay card or coupon that they redeem at their pharmacy. Historically, this assistance has counted toward their deductible. Copay accumulator programs prevent this assistance from counting toward a patient’s deductible, which creates significant financial challenges for the patient.

CMS’ rule does not require health insurers to end this practice, but rather requires drug manufacturers to ensure their assistance is going directly to the patient. With copay accumulator programs in place, this is an impossible feat.

Join us in the fight for patients’ rights and learn more about copay accumulator programs here.