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Call to Action: Improve Patient Access to Critical Medications in DC

DC Council: Vote "Yes" on 2nd Reading to Give Patients Access to Affordable Prescription Drugs!


DC Councilmembers have legislation (B21-32, the Specialty Drug Copayment Limitation Act of 2016in front of them which literally can be a lifesaver for patients. Originally introduced in January 2015, the legislation would help reduce the financial burden felt by District patients at the pharmacy counter. Health insurers are increasingly using cost-shifting, a tactic of shifting the cost of high cost drugs from the insurer to the patient, placing excessive financial burden on patients and causing too many to go without necessary medications. What’s the purpose of insurance if it doesn’t insure? This legislation will limit the burden of out of pocket expense to the patient to $150 for a 30-day supply, and $300 for a 90-day supply of these drugs.  It's time for the Council of the District of Columbia to pass the Specialty Drug Copayment Limitation Act and provide DC patients greater access to affordable medications!


The Council of the District of Columbia held a First Reading on the legislation on December 6, 2016 and the Council approved the bill with amendment. The bill is now in the final stages of review.  Physicians are encouraged to thank the Councilmembers for passing this lifesaving legislation, especially those listed below.

 

WHOM TO CONTACT: KEY COUNCIL MEMBERS 

  Phil Mendelson (Chairman)           pmendelson@dccouncil.us 
  David Grosso                                    dgrosso@dccouncil.us
  Jack Evans                                        jevans@dccouncil.us
  LaRuby May                                       LMay@dccouncil.us
  Kenyan McDuffie                               kmcduffie@dccouncil.us
  Yvette Alexander                               yalexander@dccouncil.us
  

WHOM TO THANK: BILL SUPPORTERS

   Mary M. Cheh (Introducer)            mcheh@dccouncil.us   
   Anita Bonds (Introducer)               abonds@dccouncil.us   

   Charles Allen (Co-Sponsor)        callen@dccouncil.us    
   Brianne Nadeau (Subcommittee Chair)
     bnadeau@dccouncil.us      

   Elissa Silverman                             esilverman@dccouncil.us  

   Brandon T. Todd                              btodd@dccouncil.us
   Robert C. White, Jr.                         rwhite@dccouncil.us                        
  
 

SAMPLE EMAIL LANGUAGE TO KEY COUNCILMEMBERS PRIOR TO DECEMBER 6 HEARING


I am a physician in the District of Columbia and am writing to request that you vote "Yes" on B21-32, the Specialty Drug Copay Limitation Act of 2016, at its First Reading on December 6. If passed, this bill can be a lifesaver for patients. The legislation will stop a tactic increasingly being used by health insurers to shift the cost of high cost drugs from the insurer to the patient. Existing law allows insurers to implement a coinsurance amount, which can result in thousands of dollars of expense to the patient each month! The result has been that too many patients cannot afford needed medications and go without. What’s the purpose of insurance if it doesn’t insure? This legislation will limit the out of pocket expense to the patient to $150 for a 30-day supply, and $300 for a 90 day supply- not insignificant amounts- making necessary, lifesaving medications more affordable.

The bill had a hearing before the Committee on Business, Consumer and Regulatory Affairs late last year. Councilmember Brianne Nadeau made several improvements to the bill, resulting in a unanimous approval vote at mark-up in November.

As a physician of the District of Columbia, I and the many patients whom I treat each and every day, ask for a “yes" vote on the December 6th First Reading. Thanks you for your consideration.


SAMPLE EMAIL LANGUAGE TO BILL SUPPORTERS

I am a physician in the District of Columbia and I thank you for your support of B21-32, The Specialty Drug Copayment Limitation Act.  This bill will help reduce the financial burden felt by District patients at the pharmacy counter and ensure affordable access to necessary medications. 


B21-0032: ABOUT THE BILL

   Access to prescription drugs for District patients is important to patient health, but excessive drug copays have made access to needed medications increasingly difficult for patients. B21-32, the Specialty Drug Copayment Limitation Act of 2015, is specific to specialty drugs and would cap a patient’s out of pocket cost at $150 per month for a thirty day supply of that medicine. These medicines are generally newer and significantly help patients protect health.

   The legislation received a Public Hearing by the Committee on Business, Consumer and Regulatory Affairs last year. (See the Medical Society's testimony). The bill was referred to Subcommittee on Consumer Affairs, and Councilmember Nadeau, in her role as Subcommittee Chair, made several improvements to the bill- resulting in a unanimous approval vote at mark-up in November 2016. (See the Subcommittee Mark-up.)

 

  

KEY FACTS AND BACKGROUND

  • Read the 2015 Washington Post Op-Ed. This Washington Post Op Ed describes the impact of cost-shifting on patients in DC.
    Patients in neighboring jurisdictions have protections against excessive drug copays. Bills similar to DC's B21-0032 have passed in Maryland and Delaware and are under review in Virginia.
  • High drug copays have serious consequences for patient health and treatment adherence.  A research study published in the Journal of Clinical Oncology found that patients with higher co-payments were 70 percent more likely to stop their medication, and were 42 percent more likely to skip doses than patients with low co-payment.
  • Access to prescription drugs for District patients is important to patient health, but excessive drug copays have made access to needed medications increasingly difficult for patients. Read this Backgrounder
  • According to a recent study from the Avalere Healthcare Research Company, more than 41% of silver plans on the healthcare exchange now have coinsurance rates of 30% or more.

  • The Specialty Drug Copayment Limitation Act would help reduce the financial burden on patients felt at the pharmacy counter.

  • The ACA doesn't fix the issue. Despite the protections in the ACA, patients are still exposed to the significant cost-sharing. Although the ACA establishes a maximum annual limit on out-of-pocket spending, spending for individual services and drugs IS NOT capped.

  • Although any DC patient might be affected by high co-insurance, those patients most affected likely include those living with chronic illnesses, such as rheumatoid arthritis, hemophilia, multiple sclerosis and those with life-threatening conditions such as HIV, breast cancer, colorectal cancer and leukemia

  • The DC Council should not squander this opportunity to help patients get affordable access to necessary medications.

The DC Council Should Vote "Yes" for the Specialty Drug Copayment Limitation Act on December 6.

 

 

 

 

 


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