September 12, 2019

Two States Step Forward

Illinois – Dumps Co-Pay Accumulators

On August 26, Illinois Governor JB Pritzker signed House Bill 465 making it illegal for insurers to refuse to honor the co-pay cards that pharmaceutical companies sometimes provide as an inducement to consumers’ purchasing their medicines. Illinois is the tenth state to prohibit insurers from refusing to honor such discount cards (see 4/25/19 column for more information). Last April, the federal Centers for Medicare and Medicaid Services (CMS) also prohibited the imposition of Co-Pay Accumulator practices (the insurance industry’s term for refusing to accept the value of co-pay coupons) on people receiving Medicare or Medicaid unless a generic alternative of the required drug was also available to them as a cost-saving alternative.

Illinois’ new law on this, scheduled to become active next January 1, specifically requires insurers to apply “third-party payments, discounts, vouchers and co-pay cards to a deductible, the co-pay or out-of-pocket maximum associated with health insurance.” The new law also bans “gag clauses” that limit pharmacists from alerting patients that lower cost drugs may be available and when paying in cash may be cheaper than applying the cost of a medication to your insurance. To date, ten states have banned the co-pay accumulator practices altogether. They are California, District of Columbia, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Ohio and Virginia.

Texas – Agrees to Make HIV Meds Available Without Prior Authorization

Last May, CMS finally ruled that HIV would remain as the only one of the formerly “six protected classes” designated by Congress over a decade ago to continue to be exempt from all access restrictions recently imposed by Medicare Part D on other drugs for chronic illnesses. CMS’s national decision not to restrict access to antiretroviral treatment (ART) for Medicare recipients, however, did not guarantee that state-level Medicare programs would follow suit. There was no certainty, for example, that Texas – a state with the sixth highest HIV rate in the country and unexpanded Medicaid – would still provide uninterrupted access to ART to Texans living with HIV.

On July 2, however, Texas Governor Greg Abbott signed Senate Bill 1283 into law, effectively protecting Texan Medicaid recipients living with HIV by prohibiting the application of prior authorization and step therapy techniques to the provision of ARVs, much to the surprise of many people following the issue.

Earlier this year, Abbott became one of the southern governors to oppose Texan legislators attempting to target the LGBTQ community by passing legislation limiting access to public restrooms and locker rooms to one’s birth-assigned gender. In his first term, Abbott had supported “bathroom bills.” But in 2018, when he had to run for re-election against former sheriff Lupe Valdez – “the first openly gay major party candidate for governor in state history” according to – he announced that the “issue was no longer on his agenda.”

There’s an old cliché in politics describing how democracy should work. “If you can’t change the minds, change the faces.” It’s good to remember that both can work.

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