States across the country are considering legislation that would limit out of pocket costs for super-expensive specialty drugs for chronic diseases such as hemophilia, multiple sclerosis, and Crone's disease. These drugs can cost as much as $20,000 - $100,000 or more per year, and some insurance plans have started charging co-insurance of 50%. The experiences of patients can be very persuasive to legislators considering bills to cap such costs or otherwise regulate specialty tiers.
Pending legislation in Vermont, Senate Bill 221 which is sponsored by NLARx Board Vice Chairman Senator Kevin Mullin, would cap out of pocket prescription drug costs, including for specialty drugs, at $1,000 per insured individual and $2,000 per insured family. Vermont previously passed a moratorium on specialty drug tiers in insurance effective July 1, 2012 in order to give the Legislature time to consider a longer term solution to the issue.
Maine legislation, LD 1691, that would bar specialty drug tiers was amended in committee and voted out 9-4 in favor. The amended bill may still face an uphill battle on the floor. As amended, the bill would require specialty prescription drugs to be included within any cap on out of pocket spending in an insurance policy executed or renewed on or after January 1, 2013. The provision is similar to language in the Affordable Care Act that would become effective January 1, 2014. This and other legislation is being brought forward by the drug manufacturers; in the Maine instance by Pfizer, according to bill sponsor Rep. Stacy Fitts.
A bill analysis prepared last month by the nonpartisan legislative staff found that specialty tier legislation has also been enacted in New York (Chapter 536, NY Laws 2010), was killed in Maryland, and is pending in California (AB 310), Connecticut (Raised Bill 1084), Kansas (HB 2136), Nebraska (LB 1017) and Washington (HB 1876). Read the staff analysis here.
Read all of the NLARx February 29, 2012 Newsletter
