SB 1401 Keeps People Off of Taxpayer Funded Health Plans, Alleviates Unfair Out-of-Pocket Costs
PHOENIX, Feb. 29, 2012 /PRNewswire/ -- The Arizona Alliance for Chronic Care (AACC), an assembly of 21 organizations representing thousands of Arizonans living with complex medical conditions such as cancer, multiple sclerosis, hemophilia, rheumatoid arthritis, Lou Gehrig's disease and many others, marks a small win with the advancement of SB 1401. Scheduled to be heard in the next few weeks, SB 1401 protects patients from new, unfair out-of-pocket costs and keeps budgeting for specialized prescriptions predictable.
"SB 1401 assures that working class people with chronic conditions can continue to pay their own way and afford needed prescriptions," said Cindy Komar, executive director of the Arizona Hemophilia Association and member agency of the AACC. "Long term it could keep people out of 'indigent' status and off of healthcare programs paid for by the Arizona tax payer."
SB 1401 is practical, fair legislation that protects Arizonans who require specialized prescriptions to live or maintain their quality of life. Across the nation, these patients are being targeted by insurance plans trying to carve out higher profits by categorizing medication by a cost-related tier formulary. Referred to as 'specialty tiers' by health plans the approach is a cost-sharing tactic that disproportionately impacts patients suffering from chronic diseases—many of which require a lifetime of medication to treat. Drugs in a specialty tier are assigned coinsurance rates where the patient pays a percentage of the drug cost; a drastic difference to the set dollar amount co-payments which most consumers are accustomed to.
For people living with chronic conditions the specialty tier trend could lead to bankruptcy and devastating changes in overall health and quality of life. Real-life local scenarios from AACC members, willing to share their stories personally in more depth upon request, speak volumes:
One Arizona single mother with a/an 12-year old son with severe Hemophilia B faces medicine costs that are more than $1 million a year, being tacked with co-insurance would bankrupt her.
An Arizona mom and dad, employed by the same company, have a 1-year old son recently diagnosed with severe Hemophilia A. Their monthly co-insurance is $2,000, a cost that the family cannot afford, yet without access to needed medicine it would lead to permanent, debilitating damage or death for their child.
One Arizonan with hemophilia, who contracted HIV and hepatitis C from transfusions, has $8,000 out of pocket costs for their hemophilia medicine, costs that are not affordable. The result is that he experiences bleeding forcing him into the emergency room for treatment—a costly approach for a chronic condition that also places him at risk of permanent damage because of inconsistent care.
SB 1401 is a simple, reasonable approach to keeping prescriptions accessible to patients and empowering them to manage their healthcare, including:
Informing patients about the intention to change a drug to a higher tier, making the details easy to find (searchable) on the company website.
Providing patients a 60-day notice if there are plans to move a drug to a higher tier.
Allowing patients to complete the agreed-to terms of a contract year without reclassifying biologics or plasma-derived prescriptions drugs to a higher tier of a multi-tiered drug formulary mid-contract.
Allowing patients with prescription drug benefits who pay deductibles, copayments, co-insurance or other out of pocket expenses during the term of the contract; to apply those dollars toward any annual out of pocket maximum amount defined in the contract.
Allowing patients to budget for their healthcare by making the maximum out of pocket expenses no more than $3,000 for an individual and $5,000 for a family.
With more than 2.5 million Arizonans living with some type of chronic condition, SB 1401 is timely and makes sense. Some experts believe that It's been proven that with the right disease management tools— including access to needed prescriptions— patients consume less health resources in the form of inpatient hospital stays, diagnostic testing, physical therapy and more.
The AACC represents more than 31 prominent Arizona-based organizations that advocate for a variety of chronic illnesses. To see a full list of the current membership and to join the effort visit http://arizonaallianceforchroniccare.org.
SOURCE Arizona Alliance for Chronic Care