On May 28, 2015, Senate Bill 841 was introduced by Senator Bob Mensch to limit costs for specialty-tier medicines in Pennsylvania to $100/mo. To date, it still has not been considered in the Senate Banking and Insurance Committee. It must be considered and moved out of committee in order to pass. SB 841 can make a difference in Pennsylvania by helping to limit cost sharing for vital medications that are lifesaving to so many.
The Center for Medicare and Medicaid Services (CMS) has proposed a new experimental Medicare Part B drug reimbursement plan that would reduce payments to providers for Part B drugs like immunoglobulin (Ig) and its administration by a provider. This experimental plan is intended to reduce Medicare costs. However, this initiative solely focuses on cost-savings rather than access to quality healthcare for patients and patient outcomes. The proposed reduction in reimbursement will likely reduce the ability of providers to afford and provide Ig infusions in the hospital, outpatient and physician office settings. Patients could face serious access to care issues upon implementation of this new model. Medicare beneficiaries with life-threatening conditions such as primary immunodeficiency diseases (PI) could encounter an abrupt halt accessing their treatments that would create life-threatening consequences.
As part of the Affordable Care Act of 2010, an annual 40% excise tax on “high-priced” employer-sponsored health insurance plans will begin in 2018. This was instituted with the goal to help improve savings and reduce costs within the U.S. healthcare system. By discouraging higher value plans, in theory, patients would be more selective when utilizing the healthcare system. The drafters of this legislation assumed, at the time it was passed, that this tax would affect only very high-priced “Cadillac” or “luxury” employer sponsored healthcare plans. Unfortunately, this is forcing many employers to explore ways to avoid the tax by lowering the cost of their health plans, and many are already shifting costs to their employees in the form of higher deductibles, co-payments, and out-of-pocket maximums. Click here to learn more about the Cadillac Tax.
H.R. 1600, the Patients’ Access to Treatments Act (PATA), seeks to restrain high out-of-pocket costs for specialty medications like immunoglobulin (Ig). This bipartisan legislation will help ensure patients with chronic, disabling and life threatening conditions to access the treatments they need. If passed, the bill would limit out-of-pocket costs for medications in a specialty drug tier (typically Tier IV or higher). Click here to learn more about H.R. 1600 – Patients’ Access to Treatments Act (PATA).
The 21st Century Cures Act (H.R. 6) is a nonpartisan issue that if passed by Congress will have a profound effect on the lives of all Americans. The bill will bring our healthcare innovation infrastructure into the 21st Century, delivering hope for patients and loved ones while providing necessary resources to researchers to continue their efforts to uncover the next generation of cures and treatments. Click here to learn more about the 21st Century Cures Act.