Today’s Managing Health Care Costs Number is $530 Million
New York State passed a bill prohibiting insurers and pharmacy benefit managers from requiring “step therapy,” where patients must first try a lower priced medication before they get authorization and receive insurance coverage for a higher priced medication.
The bill was passed at the end of 2016 and takes effect right now- which is a problem for health plans which have already created 2017 budgets (and set premiums)– and now face an unexpected new cost. Actions like this encourage health plans to build “padding” into their premium rates – which make health insurance less affordable or encourage plans that strip out important benefits to cover such contingency funds.
The bill was fashioned as “consumer protection,” as it provides a better benefit without any hassle for patients whose physicians prescribe expensive medications. However, there are tradeoffs. An industry group says the increased cost will be $530 million.
According to newyorkupstate.com:
The new law was hailed by the U.S. Pain Foundation.
"Patients deserve timely and medically necessary treatments without insurance companies interfering with their treatment plan," Paul Gileno, president of the U.S. Pain Foundation, said in a prepared statement.
You won’t be surprised that pharmaceutical companies are the major sponsors of this foundation.
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