Consumer Representatives Issue Recommendations For State And Federal Policymakers On Improving Prescription Drug Access For Consumers

Experts

Director, Special Projects

New Report Outlines Policies to Promote Access to Affordable Prescription Drugs

SAN DIEGO, CA – As high drug prices continue to strain family budgets and put treatment out of reach for many consumers, a diverse group of patient and consumer advocates released a set of recommendations for state and federal policymakers to help ensure that consumers have access to the affordable prescription drugs that they need.

The report, Promoting Access to Affordable Prescription Drugs: Policy Analysis and Consumer Recommendations for State Policymakers, Consumer Advocates, and Health Care Stakeholders, provides a series of recommendations to assist regulators, lawmakers, and the National Association of Insurance Commissioners (NAIC) on ways to promote access, affordability, nondiscrimination, transparency, and meaningful oversight of prescription drug coverage. An overview of the report will be provided to state insurance commissioners during the NAIC/Consumer Liaison Committee meeting on Sunday, August 28th during the NAIC Summer 2016 National Meeting in San Diego, California.

The report includes examples of existing state and federal approaches to addressing these issues as well as recommendations for consumer-protective policies to be considered by state and federal policymakers. The report addresses specific topics such as drug cost-sharing, adverse tiering, mid-year formulary changes, data collection and analysis, and value-based pricing, among many others. Key recommendations include encouraging policymakers to:

  • Limit the number of drug tiers that insurers can use;
  • Limit consumer cost-sharing by, for instance, prohibiting coinsurance for prescription drugs;
  • Adopt standardized plans with meaningful cost-sharing limits to mitigate adverse tiering;
  • Prohibit mid-year formulary changes that negatively affect enrollee access to drugs;
  • Require formularies to be updated weekly and include information about drug tiering, the actual dollar amount of any cost-sharing, any utilization management or network restrictions, and the process to request a drug exception, among other information;
  • Collect standardized, plan-level data to enable the development of consumer tools and apps; and
  • Solicit feedback from external stakeholders—such as advocates, other state agencies, ombudsmen, and independent medical experts—to inform the formulary review process.

The authors of the report serve as appointed consumer representatives to the NAIC and members come from national organizations such as the American Cancer Society Cancer Action Network, the American Heart Association, Consumers Union, and the National Alliance on Mental Illness; state-based advocacy organizations such as the Colorado Consumer Health Initiative, Georgians for a Healthy Future, and the Mississippi Health Advocacy Program; and academic centers such as Washington & Lee School of Law and Georgetown University.

Betsy Imholz, Special Projects Director at Consumers Union, remarked, “The affordability of prescription drugs is a matter of serious public concern. This report provides a set of recommendations for regulators—with an emphasis on the latest research and state-based examples—on ways to help ensure that consumers can access the life-saving medications they need.”

Anna Howard, the Principal for Policy Development, Access to and Quality of Care at the American Cancer Society Cancer Action Network, noted, “As consumer advocates, we recognize that high drug prices are a complex policy issue that demand a range of innovative approaches by federal, state, and industry policymakers. However, state regulators and lawmakers play a critical role in protecting consumers, promoting access, and developing innovative approaches. We hope this report will inform regulators’ efforts to promote access to affordable prescription drugs.”

“State lawmakers and regulators have long led the way in adopting health reform and policy changes that make a real difference for consumers,” said Debra Judy, Policy Director at Colorado Consumer Health Initiative. “Access to prescription drugs is no different: As this report shows, state policymakers can play an important role in providing consumers with affordable medications.”

Contributing to the report were NAIC consumer representatives Elizabeth Abbott, California Office of the Patient Advocate; Bailey Acevedo, Community Service Society of New York; Bonnie Burns, California Health Advocates; Deborah Darcy, American Kidney Fund; Adrienne Ellis, Mental Health Association of Maryland; Marguerite Herman, Consumer Advocates: Project Healthcare; Anna Howard, American Cancer Society Cancer Action Network; Betsy Imholz, Consumers Union; Timothy Stoltzfus Jost, Washington and Lee University School of Law; Debra Judy, Colorado Consumer Health Initiative; Amy Killelea, National Alliance of State & Territorial AIDS Directors; India R. Hayes Larrier, New Jersey Citizen Action; Angela Lello, Autism Speaks; Claire McAndrew, Families USA; Roy S. Mitchell, Mississippi Health Advocacy Program; Stephanie Mohl, American Heart Association; Lincoln Nehring, Voices for Utah Children; Jesse Ellis O’Brien, Oregon State Public Interest Research Group, Inc.; Pam Silberman, University of North Carolina Gillings School of Global Public Health; Andrew Sperling, National Alliance on Mental Illness; JoAnn Volk, Georgetown University Center on Health Insurance Reforms; Silvia Yee, Disability Rights Education and Defense Fund; and Cindy Zeldin, Georgians for a Healthy Future.

###

Contact Information
For more information about Promoting Access to Affordable Prescription Drugs: Policy Analysis and Consumer Recommendations for State Policymakers, Consumer Advocates, and Health Care Stakeholders, please contact Katie Keith at katie.keith@georgetown.edu or Anna Howard at anna.howard@cancer.org.