Our Advocacy Issues, cont.

need monthly refills. Because there is no cure for bleeding disorders they may need a prior authorization every month for medication the health plan already promised to cover. Delays and denials mean the patient can go without factor, risking serious bleeding and lasting complications.

What is being done:

Last year, A.7129 (Gottfried) / S.6435a (Breslin) created common sense guidelines for the use of prior authorization by health plans and PBM’s. The guidelines were designed to allow for prior authorization to be used in a way which didn’t delay treatment for patients or add unnecessarily to the burden on medical staff.

Unfortunately, this bill was not passed by the Legislature. We continue to work with the Legislature, as well as with other stakeholders to craft and introduce a bill which would help to ensure that prior authorization requirements do not negatively impact patient care.

Prescription Drug Pricing Transparency

The issue:

The cost of prescription drugs have always increased high- er than the rate of inflation, and no one understands how the prices of drugs keep going up and up. There is no real mechanism on how high they can rise. Additionally, prices can randomly rise during the middle of the year, after an individual has selected their health insurance plan.

What can be done:

The Governor has proposed “The Prescription Drug Price and Supply Chain Transparency Act of 2023” in the Health and Mental Hygiene Article VII as part of the State Budget This legislation would require prescription drug manufacturers to report price increases in advance, including the reasons for the increase and a requirement to provide consumers advance notice of proposed prescription drug price hikes, and require disclosure of or a ban on ‘pay for delay’ deals by which brand name drug makers pay generic manufacturers to keep their cheaper generic versions off the market for nearly 17 months on average. The Governor’s plan would also empower the New York State Department of Financial Services to investigate drug manufacturers’ assertions as to reasons for price increases, building upon the agency’s existing authority to investigate certain price spikes

National Advocacy Issues

HELPCopays Act

Although New York State has passed legislation ensuring that all health insurance programs overseen by the State mandate that all co-pay assistance be counted toward an individual’s out of pocket costs, this does not impact employer-funded health insurance (ERISA) plans. In order to extend these proctections to ERISA plan members, it is necessary to pass legislation at the federal level.

The Help Lower Patient Copays Act (HELP Copays Act) is a bi-partisan, two-part solution that: Clarifies the ACA definition of cost-sharing to ensure payments made “by or on behalf of” patients count toward their deductible and out of pocket maximum. Closes the Essential Health Benefits (EHB) loophole to ensure that any item or service covered by a health plan is part of the EHB package so that all related cost-sharing counts toward a patient’s cost-sharing limits.

In the House, HR 830 was introduced by Reps. Carter (RGA) and Barragan (D-CA). The Senate has yet to introduce a companion bill.

Federal Programs

We support funding for the following programs:

· The National Heart, Lung and Blood Institute at the National Institutes of Health (NIH).

· The Maternal and Child Health Bureau at the Health Resources and Services Administration (HRSA), which provides funding to HTCs and allows them to participate in the 340B program.

· The Division of Blood Disorders at the Centers for Disease Control and Prevention (CDC).