Transcript Access to Prescription Drugs - American Academy of Dermatology

Collaboration Between
CSD and AAD
Mark Lebwohl, MD
President
American Academy of Dermatology
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Narrow network legislation
Access to Therapy legislation
Patient Access to Treatment Act
21st Century Cures Act/American Cures Act
IPAB repeal
Barbara Greenan
Shawn Friesen
Senior Director
Director, Legislative,
Political &
Grassroots
Advocacy
COST OF DRUGS IS KILLING US!
PREFERRED DRUG LISTS:
WHICH SPECIALISTS ARE MOST AFFECTED?
Source: Health Strategies Group, Payer Landscape for Specialty Pharmaceuticals, October 2014.
On average how long does it take to obtain prior authorization
for biologic therapy per patient?
120
100
80
% Responders
60
# Responders (out of 274)
40
20
0
< 15 minutes
15 - < 30
minutes
30 - < 60
minutes
More than 60
minutes
Have reimbursement hurdles prevented
you from using what you consider to be
the ideal therapy for a psoriasis patient?
82%
248
18%
54
YES
NO
ENJOYMENT INDEX
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10
8
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4
2
0
11
10
10
8
5
3
2
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Access to Prescription Drugs:
State Level
• AADA is an active member of the State Access to
Innovative Medicines Coalition (SAIM)
• SAIM Coaltion’s purpose:
– Pursue step-therapy model legislation
– Pursue legislation that limits prescription drug out-ofpocket costs
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Access to Prescription Drugs:
State Level
• AADA was instrumental in drafting SAIM’s model step
therapy legislation, which requires insurers to honor
certain rules and requirements if using step therapy.
• This year, step therapy legislation was introduced in:
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California
Illinois
Florida
Maine
Massachusetts
Missouri
New York
North Carolina
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STEP THERAPY
Access to Prescription Drugs:
State Level
Tiered Cost-Sharing
• Mechanism to encourage patients to try lower-cost
medications before turning to more expensive ones.
• Can require a patient to pay as much as 50% of a
drug’s cost, which can amount to significant sum for
30-day supply
• Many higher tiers include a significant number and
range of medications
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Access to Prescription Drugs:
State Level
The AADA worked with the SAIM Coalition to limit patient co-pays:
 Connecticut: Limits coinsurance, copays,
deductibles and other OOP expenses;
specifies how such limits apply to high
deductible health plans
 California (regulatory): Majority of state
exchange’s beneficiaries will have monthly
payments for specialty drugs capped at $250
per month, although caps will range from
$150 to $500.
 Colorado (regulatory): Caps 30-day supply
at 1/12 of a policy holder's maximum
allowable annual out-of-pocket.
 Illinois: $100 cap per 30-day supply for silver
/ gold / platinum; $200 cap per 30-day supply
for bronze
 Kansas: $100 cap per 30-day supply; $200 total
monthly cap; Applies pre-deductible.
 Kentucky: Senate bill- $100 per Rx cap; $200
total monthly cap; House bill- same cap but it
applies only to "drugs on a specialty tier
 Michigan: $100 per Rx cap
 Nevada: $50 cap per 30-day supply
 Oregon: combined copays and coinsurance for
a 30-day supply may not exceed $100
 Virginia: Limit copays / coinsurance to $100/
month for 30-day supply of any single drug
 Washington, DC: $150 monthly cap for all drugs
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Access to Prescription Medication
Federal Level
• AADA supports Patients’ Access to Treatments Act (PATA)
– Limits cost-sharing requirements for drugs in the specialty tier
(typically Tier IV or higher) to the co-pay dollar amount applicable
to drugs in a non-preferred brand tier (typically Tier III)
– 26 patient and physician organizations support PATA
– 85 co-sponsors (69 (D) and 16 (R))
• AADA is part of Coalition for Accessible Treatments (CAT)
– Urged inclusion of PATA in the 21st Cures legislation
– Encouraged Congress to form a roundtable group of providers,
insurers, and manufacturers to address the issue of access to
treatments
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Access to Prescription Medications
AADA Task Force
• AADA established a Drug Pricing and Transparency
Taskforce
– Examining the issues of drug pricing and transparency
– Identifying partners for collaboration
– Advocating for achievable outcomes to help patients access
needed treatments
• AADA is convening a Dialogues on Drug Pricing and
Transparency panel at Summer Academy Meeting
– Experts from pharmaceutical manufacturers, pharmacy
benefit managers, private payers, prescribers, and patient
groups
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Drug Pricing &
Transparency Task Force
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David Brewster
Assistant Dir.,
Practice Advocacy