Patient Protection Legislation to Cap Out-of-Pocket Costs for Vital Medications Referred to Virginia Health Insurance Reform Commission for Further Study

SB 1394 Would Limit Medication Price Discrimination against Insured Virginians; Fair Copay VA to Work with Commission to Address Problem of Prohibitive Out-of-Pocket Costs  

RICHMOND, VA. (March 3, 2015) – Fair Copay VA, a patient-focused campaign dedicated to ensuring that Virginians who have paid their insurance premiums are able to access the medical treatments they need, today announced that Virginia Senate Bill 1394, legislation to limit medication price discrimination for insured Virginians, has been referred to the Virginia Health Insurance Reform Commission for further study.

“Some Virginia health insurers have erected barriers to treatment for patients living with chronic and life-threatening conditions. So-called ‘specialty tier’ insurance price structures can increase patient costs by hundreds or thousands of dollars per month, and no family should have to choose between their health and basic needs,” said Dana Kuhn, Ph.D., president and founder of Patient Services Inc. “We are grateful for the support we received from Virginia legislators, patient and provider groups, and families from across Virginia. We look forward to working with Chairperson Byron and the other members of the Commission to find a solution to the growing problem of burdensome out-of-pocket costs.”

Prescription drug benefit plans traditionally include a three-tiered drug formulary, with copay limits for each tier, but health insurers are increasingly moving treatments to “specialty tiers,” where there are no limits on what a beneficiary is required to pay. SB 1394, introduced by Sen. Rosalyn Dance (and HB 1948, companion legislation introduced by Del. Jennifer McClellan) would increase access to medications by ensuring that the required copayment or coinsurance applicable to drugs on a specialty tier does not exceed $100 per month for a 30-day supply.

Although any Virginian could be subjected to unreasonably high out-of-pocket costs, those most likely to be affected are living with life-threatening or chronic conditions, such as cancer, hemophilia, rheumatoid arthritis, hepatitis C, multiple sclerosis, epilepsy, lupus, and HIV/AIDS.

Groups supporting the Fair Copay VA campaign included: Arthritis Foundation, Epilepsy Foundation of Virginia, HealthHIV, Hemophilia Foundation of America (HFA), Immune Deficiency Foundation, Lupus Foundation of America – DC/Maryland/Virginia Chapter, National Organization for Rare Disorders (NORD), National Patient Advocate Foundation, Virginia Breast Cancer Foundation, Virginia Consumer Voices for Health Care, Virginia Hemophilia Foundation, and Virginia Organizations Responding to AIDS (VORA).

Several states across the country, including New York, Vermont, Maine, Delaware, Maryland, Louisiana and Montana, have already implemented copay limitations.

For more information on the Fair Copay VA campaign, efforts to cap patient out-of-pocket costs, and updates on progress with SB 1394, visit www.faircopayva.org.

Additional Resources

For a Richmond Times-Dispatch column from Del. Jennifer McClellan on the importance of limiting patient out-of-pocket costs, click here.

For a Richmond Times-Dispatch column from PSI President Dana Kuhn on the need for a legislative solution to skyrocketing patient out-of-pocket costs, click here.

For a Washington Post story examining the ways that insurers are using specialty tiers to discriminate against patients, click here.

About Fair Copay VA

Fair Copay VA – led by Patient Services, Inc. – is a patient-focused campaign dedicated to ensuring that Virginians who have paid their insurance premiums are able to access the medical treatments they need when they or someone in their family gets sick. Fair Copay VA advocates for a legislative solution to limit out-of-pocket costs for vital medications. For more information, visit www.faircopayva.org.

About PSI

Patient Services, Inc. (PSI) is the "ground breaking" 501(c)(3) non-profit, charitable organization of its kind. Founded in 1989 by Dana Kuhn, Ph.D., the Midlothian, Virginia, based company has helped people who live with specific chronic illnesses or conditions locate suitable health insurance coverage and access ways to satisfy expensive co-payments. PSI provides assistance with the cost of health insurance premiums associated with COBRAs, State High Risk Pools, Open enrollment, Guaranteed Issue policies, HIPAA conversion policies; and prescriptions co-payments associated with private insurance as well as with Medicare Parts B and D.

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