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Support for Rhode Island’s H 8041 “An Act Relating to Insurance—Prescription Drug Benefits”

Apr 4, 2024

We voice our strong support for Rhode Island’s H 8041 (“An Act Relating to Insurance—Prescription Drug Benefits”) which stipulates that, when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health plan, an insurer or pharmacy benefit manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person. We thank you for considering this legislation and are pleased to offer our support.

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Testimony on the selection of drugs for referral to MD stakeholder council

Mar 20, 2024

We believe Maryland policymakers should focus on those issues that directly impact patients, such as PBM regulation and reform, standard plan designs with reasonable deductibles and nominal copays, and ensuring copay assistance counts. We note that the General Assembly is currently considering HB 879, legislation that would ensure that copay assistance programs will count toward deductibles and out-of-pocket maximums, and the Senate is considering SB 595.

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Comments on ERISA’s 50th anniversary–reforms to increase affordability and quality in employer-sponsored health coverage

Mar 15, 2024

Employer-sponsored insurance is the most common form of health insurance in the United States, covering over 60 percent of the population under 65.[1]  As we detail below, many employers have begun to create new health insurance barriers that prevent employees and their family members from accessing the medications they need to stay alive and healthy.  Our comments focus on certain novel benefit designs that have become more prevalent in recent years among employer-sponsored insurance plans: copay accumulators, copay maximizers, and alternative funding programs, as well as the practice of skirting ACA requirements by designating certain specialty medications as non-Essential Health Benefits.

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Testimony on the IL Health Care Availability and Access Board Act (HB 4472)

Mar 12, 2024

We believe policymakers should focus on those issues that directly impact patients, such as PBM regulation and reform, standard plan designs with reasonable deductibles and nominal copays, and ensuring copay assistance counts. We realize that Illinois has taken many of these steps already, and that Illinois policymakers are advocating for change at the national level, too, but more can be done.

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Amicus brief with patient groups on California Rule of Court 8.500(g) on the “duty to innovate”

Mar 8, 2024

Given the importance—and immense cost—of developing new treatments and cures, Amici have a profound interest in ensuring that the law not disincentivize innovation. Amici were accordingly concerned to learn of the new legal duty recognized by the Court of Appeal in this case, which would impose liability on manufacturers of drugs that are undisputedly safe and effective as approved by the FDA itself. The new duty is indifferent to the safety of the existing product, imposing liability if a manufacturer “knew” it could potentially make an even “safer” alternative.

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