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New Delaware Law Limits Out-of-Pocket Costs for Specialty Medication


Delaware Governor Jack Markell signs SB 35 into law, July 23, 2013.

Increasingly, insurers are cutting their costs by shifting expenses onto patients in the form of specialty tier co-insurance fees for specialty medications like immunoglobulin replacement therapy. When an insurer puts immunoglobulin in a specialty tier with a co-insurance, they are charging the patient a percentage of the cost of treatment rather than a flat co-payment amount. With expensive treatments like immunoglobulin, this can amount to thousands of dollars per treatment that a patient would have to pay out of pocket.

IDF is advocating against this practice by supporting legislation at the federal level and in states throughout the country. The legislation caps the amount of co-insurance fees that patients can be charged for specialty medications. In Delaware, IDF joined the Delaware Coalition Against Specialty Tiers, a group of organizations whose members also rely on expensive specialty medications, to support SB 35. This bill caps the amount that insurers can charge in co-insurance fees for specialty drugs at $150 per month for a 30 day supply.

IDF submitted testimony in support of SB 35, sent out an Action Alert encouraging patient advocates in the state to send letters to their state senators, and reached out to individual patients in the state to contact members of the Delaware General Assembly.

Ultimately, SB 35 passed in both the Senate and House of Representatives with no opposition from the insurance industry and was signed into law by Governor Jack Markell on July 23, 2013!

Click here to read the Washington Post article about the law. Click here to view photos of the signing.

Thank you to IDF patient advocate Judy Kozulak for her efforts on this issue!

If you are interested in advocating for specialty tier legislation in your state, please contact IDF.

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