There are just 10 session days remaining before the end of legislative session… yet Senate Insurance has yet to act on S.5022-C – Your help is needed! With 36 organizations in support of this bill and currently 27 co-sponsors (including Senator Serino), The Senate needs to hear from you each day over these last 11 session days. Please take a few minutes to place a couple strategic calls and also place a call to Majority Leader Flanagan’s office in tandum. Please tell them your personal story, etc. Key targets are Senator Seward, Senate Insurance and Majority leaders (see list below). You can call a toll free number set up by AARP at 844-254-6881 Thank you for your continued advocacy and efforts! (thanks to our friend and colleague Stephanie Darwak for leading these efforts).
Tomorrow, Wednesday, June 6th, will be a phone blitz day – we need 100 calls to Majority Leader Flanagan’s office. Will you leave a short message? Please see below for talking points.
Senate Majority Leader Flanagan: 518-455-2071
My name is [_____], from [CITY]. I am calling on S.5022C and urging the Senator to act now to protect my formulary plan from mid year switches. Please pass S.5022C now. The Assembly has passed this legislation 4 years in a row and we need the Senate to do the same.
You will likely just be asked for your name and leave a message. Here are some additional talking points:
– The bill is sponsored by Senator Sue Serino.
– This legislation would ensure that enrollees who select a health insurance plan based on their individual prescription drug needs have assurance that the health plan will maintain continuity in coverage for those prescription drugs during the course of the enrollment year.
– The bill does not “freeze the formulary.” Plans will be able to update their formularies as new drugs (innovations) come to market, or if drugs are declared unsafe by the FDA.
– If an “affordable alternative” comes to market, a prescriber and patient can choose to switch to that medication – there is no mandated coverage for a specific drug. Proposal only requires a health plan to keep its contractual promise to a patient whose prescriber continues to recommend a drug.
– This bill does NOT prohibit use of generics! Generic substitution is consistent with existing NY law, patients would still be able to take advantage of cost-savings if a generic comes to market under the patient protections in the bill. The vast majority of patients start with a generic, if a generic is available, and many ask to switch if a generic becomes available.
– The bill would discontinue the practice of switching medications at any time during the contract year (for non medical reasons) removing them altogether or moving them to a higher cost sharing tier resulting in higher costs for consumers and ultimately disrupting access to crucial treatments.
Additional points why this practice is a problem:
· Currently, NYS health insurance companies are allowed to make multiple formulary changes during a contract year regardless of the health impact to the patient while the patient is locked into their health plan for the duration of the contract year.
· Patients forced to switched off their medications for non-medical reasons and solely to control health plan costs can have adverse effects or disruptive outcomes, which may include: negative side effects to new therapy, treatments that are less efficacious, and a decline in adherence.
· Furthermore, switching patients for non-medical reasons can also lead to unintended consequences that increase overall health care costs (shifting the burden to the patient and other parts of the healthcare system) – and more importantly – may jeopardize patient safety such as: hospitalization, additional physician visits, additional lab tests, emergency room visits, and other associated costs.
· At the beginning of a contract year, enrollees choose their health insurance plans with thoughtful deliberation, picking a plan based on drug formulary status of necessary therapies that meets their family’s needs. A change in prescription drug availability could result in serious medical problems for the enrollee and unexpected formulary changes can be extremely financially burdensome and have unintended health effects.
Majority Leader Flanagan