Oral Chemotherapy law to open access for more patients Kentucky s new law takes effect January 2015

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Oral Chemotherapy law to open access for more patients Kentucky s new law takes effect January 2015"

Transcription

1 For Immediate Release For more information, contact Scott Sisco Oral Chemotherapy law to open access for more patients Kentucky s new law takes effect January 2015 FRANKFORT, Ky., Nov. 11, 2014 As of Jan. 1, 2015, many Kentucky cancer patients will benefit from the state s new Oral Chemotherapy Parity Bill, which passed the Kentucky Legislature in the 2014 session. Intravenous (IV)/infused anticancer medications are typically covered under a health plan's medical benefit, with patients responsible for a nominal copayment, per treatment. Orally-administered anticancer medications, however, are usually covered under a health plan's pharmacy benefit. Under the pharmacy benefit, oral anticancer medications are often included in the highest tier of a health plan s drug benefit and come with the highest out-of-pocket cost, requiring patients to pay a coinsurance or a percentage of the overall total cost of the drug. This percentage coinsurance can often equal thousands of dollars each month; a price tag that restricts access to life-saving oral anticancer therapies for untold numbers of cancer patients. On January 1, this will change for cancer patients in Kentucky, when KAR Chapter 304, as amended, goes into effect, giving patients greater access to the latest and most effective anticancer treatments. The bill, which passed at the end of the 2014 legislative session after a hard fought battle by the Kentucky Pharmacists Association, patients, patient advocacy organizations and Senator Tom Buford, limits how much health insurance companies can charge patients to no more than $100 out-of-pocket for a 30-day supply of orally administered anticancer medications. The original bill was sponsored by Sen. Buford and overwhelmingly passed both houses of the state legislature. This legislation was added to HB 126 and was signed into law by Governor Steve Beshear in April. We are proud to have been a part of the successful outcome of this important legislation needed by cancer patients, stated KPhA President Bob Oakley. Improving access to one s medication therapy by controlling out of pocket costs will increase adherence and be positive for the patient overall. The law does not require health plans to cover a new service and only impacts those that currently list chemotherapy as a covered benefit. The state law impacts residents covered by a private commercial health plan. The law does not impact the federal Medicare program. Kentucky joins 33 other states and the District of Columbia, including Missouri, Wisconsin and Ohio, in enacting similar legislation. For more information about KAR Chapter 304/HB126, please visit: Since 1879, the Kentucky Pharmacists Association has served Kentucky pharmacists in all practice settings by promoting the profession of pharmacy, enhancing the practice standards of the profession, and demonstrating the value of pharmacist services within the health care system. -30-

2 The Kentucky Pharmacists Association is the largest professional organization representing pharmacists in the Commonwealth and has been serving its members since KPhA is the voice of pharmacists from all practice settings concerning education, policy, legislative, and regulatory matters to shape and improve the future of healthcare across Kentucky and the United States. The voices of democracy speak loudly, especially when many voices join together. The Kentucky Pharmacists Association offers its members the opportunity to band together with like-minded voices to be heard. By uniting members for a single cause, KPhA can benefit pharmacists in all practice settings. We also alert our members on rapidly changing healthcare issues via multiple technologies, publications and educational seminars. Throughout its history, the Kentucky Pharmacists Association has maintained a positive and respected position in the Commonwealth's political arena. To Kentucky legislators and Kentucky executive branch officials, KPhA is the voice of pharmacy concerning legislative and regulatory matters. We are affected by the decisions of government officials, insurance companies, the Board of Pharmacy, and elected officials. Maintaining KPhA's presence in the Capitol is a high priority for the association. Political advocacy for the profession of pharmacy is vital to preserve a favorable and progressive environment for the practice of pharmacy in the Commonwealth. We believe protecting and serving pharmacists is the most important function of KPhA US 127 South * Frankfort, KY *

3 NEW LEGISLATION TO BENEFIT CANCER PATIENTS KRS Chapter 304 was amended by the General Assembly to include parity for oral chemotherapy treatment and will go into effect in Kentucky on January 1, Starting January 1, 2015 Kentucky law will limit what cancer patients, taking oral anticancer medications, have to pay each month to $100 for one thirty day treatment period. For countless patients this means a saving of thousands of dollars & increased access to the most effective therapies to treat their cancer. Kentucky Insurance Law now Limits Patient Out-of-Pocket Costs for Oral Anticancer Therapies Not a Mandate Kentucky's new law does not require insurers to provide a new benefit for cancer patients; it simply directs health plans in Kentucky who currently cover cancer treatments to limit what patients taking oral anticancer medications pay each month to $100 per thirty day treatment period. KRS Chapter 304 Change Will Not Greatly Increase Premiums for All Based on a study by Milliman, an independent actuarial consulting firm, new laws to limit patient out-ofpocket for oral anticancer will only minimally increase health insurance premiums. Specifically, the study showed an average increase of only $0.50 per member per month for most plans. This translates to a mere 0.17% increase in premiums (a typical plan within this context costs over $300 per member per month). [1] Moreover, fiscal impact studies conducted in states like Kentucky, Indiana, Missouri and a host of others, where legislation has passed, showed similar results. Flawed Benefit Design to Blame for Gap in Out-of-Pocket The disparity in patient out-of-pocket exists because coverage for an IV/injected drug is listed under a plan s medical benefit, which requires a fixed copay of $25-$50 per treatment, depending on the plan. Conversely, oral anticancer therapies are typically covered by a plan s pharmacy benefit and involve patient out-of-pocket costs ranging from hundreds to thousands of dollars per month. HB 126 amended KRS Chapter 304 to fix that. Out-of-Pocket Costs Impact Patient Compliance with Treatment Plan A study in the Journal of Managed Care Pharmacy found that patients whose monthly costs were greater than $200, for one prescription, were at least three times more likely to not fill their prescription for their oral anticancer drugs, compared to patients with out-of-pocket costs of $100 or less. Abandoning one s medication may lead to costly follow-up visits or hospitalization, among other issues. 1 Fair access to oral drugs can help prevent this outcome. Oral Anticancer Therapies Are Wave of the Future As many as 30% of new anticancer treatments in the research pipeline are in oral form, making oral therapies an increasingly important component of cancer treatment. In fact oral anticancer medications are already the standard of care for a range of cancers. Legislation to Limit Patient Costs Sweeping the States Kentucky proudly joins 34 states and the District of Columbia in enacting legislation that makes oral anticancer medications affordable for patients whose physician deems them the most effective therapies to treat their cancer. [1] Milliman, Inc. Parity for Oral and Intravenous/Injected Cancer Drugs. January Gleason PP, et al. Oral Oncology Prescription Abandonment Association with High Out-of-Pocket Member Expense. Journal of Managed Care Pharmacy, 16:

4 ORAL ONCOLOGY PARITY LAWS The way we treat cancer is changing with oral anti-cancer medications playing an increasingly important role. These therapies available in pill form directly attack cancer cells, often with fewer side effects. Oral oncology parity laws can assist patients in accessing these new innovative therapies. As of June 2014, 34 states and the District of Columbia have passed these laws. Is your state one of them? WHAT IS ORAL ONCOLOGY PARITY? Traditional anti-cancer medications are primarily administered intravenously and covered under a health plan s medical benefit, often requiring patients to pay a minimal co-pay or no cost at all for the medication. Oral anti-cancer medications are usually part of the health plan s pharmacy benefit, often resulting in high, burdensome out-of-pocket costs through coinsurance (requiring patients to pay a percentage of the overall cost of the prescription therapy). This disparity negatively impacts patient adherence 1 and forces physicians to make decisions based on outdated health plan benefit designs rather than what is best for the patient. 2 WHAT DO ORAL ONCOLOGY PARITY LAWS DO? Oral oncology parity laws are intended to address this problem of inequitable coverage between oral and IV anti-cancer medications by requiring health plans to equalize a patient s out-of-pocket costs between oral and IV therapies. The laws do not mandate coverage of oral chemotherapy, but simply state that if a health plan covers chemotherapy treatment, the patients out-of-pocket costs must be the same, regardless of how the therapy is administered.

5 WHO BENEFITS FROM THESE LAWS? As of June 2014, 34 states and the District of Columbia (DC) have passed legislation to limit patient out-of-pocket costs for oral anti-cancer medications and a number of others are expected to take action in However, state laws can only impact certain health plans and do not apply to Medicare or Medicaid. Health plans covered under the federal Employee Retirement Income Security Act (ERISA) (usually large, multi-state health plans) are also exempt. Since state laws can only protect a portion of cancer patients, a federal bill like the Cancer Drug Coverage Parity Act is important to fill the gaps. Oral oncology parity laws allow many patients and physicians to choose the right therapy that offers the most hope---without worrying about outdated health plan benefit designs that charge patients more simply because the therapy they need is only available in pill form. It is estimated that 25-35% of the therapies in the oncology pipeline will only be available in pill form. 3 These laws ensure that patients fighting cancer today and those who will be diagnosed in the future have access to the innovative therapies offering them the best chance at survival. An increasing number of state legislatures have taken steps to ensure patients have equal access to oral anti-cancer therapies. In addition to the 34 states and the District of Columbia that have passed oral oncology parity laws, there is a federal bill, the Cancer Drug Coverage Parity Act, that has been introduced in Congress. Where can I go for more information or to learn about the law in my state? Visit the State Patients Equal Access Coalition website at for more information on the important role Oral Oncology Parity laws play and to download state-specific fact sheets on all the existing state laws. For more information on efforts to pass a federal bill ensuring oral oncology parity, please visit 1 Streeter, SB, Schwartzberg, L. and Johnsrud, M. Patient and Plan Characteristics Affecting Abandonment of Oral Oncolytic Prescriptions. Journal of Oncology Practice, 7.3S 46s-51s. 2 Neumann, PJ et al. Cancer Therapy Costs Influence Treatment: A National Survey of Oncologists. Health Affairs, 29, no. 1 (2010): Geynisman, DM and Wickersham, KE. Adherence to Targeted Oral Anticancer Medications. Discovery Medicine, 2014: 17, no. 095

Ohio s Oral Anticancer Treatment Access Law: What Clinicians Need to Know

Ohio s Oral Anticancer Treatment Access Law: What Clinicians Need to Know Outdated coverage policies in Ohio USED TO limit cancer patients access to life-saving drugs! Traditionally, IV chemotherapy treatments are covered under a health plan s medical benefit where the patient

More information

The Leukemia & Lymphoma Society A powerhouse among nonprofits searching for cancer cures

The Leukemia & Lymphoma Society A powerhouse among nonprofits searching for cancer cures The Leukemia & Lymphoma Society A powerhouse among nonprofits searching for cancer cures Our Mission: Cure leukemia, lymphoma, Hodgkin s disease and myeloma, and improve the quality of life of patients

More information

Mississippi s Oral Anticancer Treatment Access Law: What Clinicians Need to Know

Mississippi s Oral Anticancer Treatment Access Law: What Clinicians Need to Know Outdated coverage policies in Mississippi USED TO limit cancer patients access to life-saving drugs! Traditionally, IV chemotherapy treatments are covered under a health plan s medical benefit where the

More information

Increasing Patient Access through Oral Parity Legislation

Increasing Patient Access through Oral Parity Legislation Increasing Patient Access through Oral Parity Legislation The Leukemia & Lymphoma Society A powerhouse among nonprofits searching for cancer cures Our Mission; Cure leukemia, lymphoma, Hodgkin s disease

More information

Florida s Oral Anticancer Treatment Access Law: What Clinicians Need to Know

Florida s Oral Anticancer Treatment Access Law: What Clinicians Need to Know Outdated coverage policies in Florida USED TO limit cancer patients access to lifesaving drugs! Traditionally, IV chemotherapy treatments are covered under a health plan s medical benefit where the patient

More information

New Hampshire s Oral Anticancer Treatment Access Law: What Clinicians Need to Know

New Hampshire s Oral Anticancer Treatment Access Law: What Clinicians Need to Know Outdated coverage policies in New Hampshire USED TO limit cancer patients access to lifesaving drugs! Traditionally, IV chemotherapy treatments are covered under a health plan s medical benefit where the

More information

Welcome to YOUR KPhA. Sullivan University College of Pharmacy July 2, 2015. Bob Oakley 2015-16 KPhA Chair

Welcome to YOUR KPhA. Sullivan University College of Pharmacy July 2, 2015. Bob Oakley 2015-16 KPhA Chair Welcome to YOUR KPhA Sullivan University College of Pharmacy July 2, 2015 Bob Oakley 2015-16 KPhA Chair Robert Bob McFalls KPhA Executive Director/CEO Mission The mission of the Kentucky Pharmacists Association

More information

Multiple sclerosis and health insurance: How to choose a plan that is right for you

Multiple sclerosis and health insurance: How to choose a plan that is right for you Multiple sclerosis and health insurance: How to choose a plan that is right for you What are the different types of health insurance? Choosing a health insurance plan is important, especially if you have

More information

Expanding Health Coverage in Kentucky: Why It Matters. September 2009

Expanding Health Coverage in Kentucky: Why It Matters. September 2009 Expanding Health Coverage in Kentucky: Why It Matters September 2009 As the details of federal health reform proposals consume the public debate, reflecting strong and diverse opinions about various options,

More information

H. R. 2739 IN THE HOUSE OF REPRESENTATIVES A BILL

H. R. 2739 IN THE HOUSE OF REPRESENTATIVES A BILL I TH CONGRESS ST SESSION H. R. To amend the Public Health Service Act to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on

More information

As Reported by the Senate Insurance and Financial Institutions Committee. 130th General Assembly Regular Session Am. S. B. No. 99 2013-2014 A B I L L

As Reported by the Senate Insurance and Financial Institutions Committee. 130th General Assembly Regular Session Am. S. B. No. 99 2013-2014 A B I L L As Reported by the Senate Insurance and Financial Institutions Committee 130th General Assembly Regular Session Am. S. B. No. 99 2013-2014 Senators Oelslager, Tavares Cosponsors: Senators Brown, Cafaro,

More information

WellPoint Cancer Care Quality Program Frequently Asked Questions California

WellPoint Cancer Care Quality Program Frequently Asked Questions California WellPoint Cancer Care Quality Program Frequently Asked Questions California WellPoint Cancer Care Quality Program What is the WellPoint Cancer Care Quality Program? WellPoint Cancer Care Quality Program

More information

2014 Prescription Drug Schedule Humana Medicare Employer Plan

2014 Prescription Drug Schedule Humana Medicare Employer Plan 2014 Prescription Drug Schedule Humana Medicare Employer Plan Option 98 City of Newport News Y0040_GHHHEF3HH14 SECTION I - INTRODUCTION TO SUMMARY OF BENEFITS Thank you for your interest in the Humana

More information

Insurance Exchanges: New Market Opportunities & Threats to Access. February 2014 avalerehealth.net

Insurance Exchanges: New Market Opportunities & Threats to Access. February 2014 avalerehealth.net Insurance Exchanges: New Market Opportunities & Threats to Access February 2014 avalerehealth.net Despite Slow Initial Enrollment, Exchange Participation Is Accelerating Most Sign-Ups Expected Close to

More information

Agenda. Medicare Overview Medicare Part B Drug Coverage Medicare Part D: How to Find and Compare Medicare Part D Plans Summary Provider Contacts

Agenda. Medicare Overview Medicare Part B Drug Coverage Medicare Part D: How to Find and Compare Medicare Part D Plans Summary Provider Contacts 2 Medicare Part D Agenda Medicare Overview Medicare Part B Drug Coverage Medicare Part D: Background Benefits of Medicare Part D Enrollment Coverage Specialty Medications Part D Costs How to Find and Compare

More information

Kansas Legislator Briefing Book 2015

Kansas Legislator Briefing Book 2015 K a n s a s L e g i s l a t i v e R e s e a r c h D e p a r t m e n t Kansas Legislator Briefing Book 2015 J-1 Kansas Health Insurance Mandates J-2 Payday Loan Regulation J-3 Uninsured Motorists Financial

More information

Arthritis Foundation Position Statement on Biosimilar Substitution

Arthritis Foundation Position Statement on Biosimilar Substitution Arthritis Foundation Position Statement on Biosimilar Substitution The Affordable Care Act creates a regulatory pathway for the approval of a new generation of biologic medications called biosimilars.

More information

REPORT SPECIAL. States Act to Help People Laid Off from Small Firms: More Needs to Be Done. Highlights as of April 14, 2009

REPORT SPECIAL. States Act to Help People Laid Off from Small Firms: More Needs to Be Done. Highlights as of April 14, 2009 REPORT April 2009 States Act to Help People Laid Off from Small Firms: More Needs to Be Done In the past two months, several states have taken action to make sure state residents who lose their jobs in

More information

18A.225 Health care insurance coverage -- Requirements of prospective carriers -- Analysis of carrier coverage data -- Agency's termination of

18A.225 Health care insurance coverage -- Requirements of prospective carriers -- Analysis of carrier coverage data -- Agency's termination of 18A.225 Health care insurance coverage -- Requirements of prospective carriers -- Analysis of carrier coverage data -- Agency's termination of participation -- Provision of amount of employer contribution

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 7.1 August 1, 2013 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international

More information

The Medicare Low Income Subsidy (LIS)

The Medicare Low Income Subsidy (LIS) The Medicare Low Income Subsidy (LIS) Extra Help with Prescription Drug Costs An overview of the Medicare LIS Patient eligibility and the application process How the LIS affects patient responsibility

More information

Northwest Georgia Oncology Centers, P.C.

Northwest Georgia Oncology Centers, P.C. Northwest Georgia Oncology Centers, P.C. High Deductibles and Out of Pocket HSA/HRA Plans (No up front collection) Medicare Advantage Plans Healthcare Exchange Plans Medicare only Cobra plans/high premiums

More information

Health Reform and the AAP: What the New Law Means for Children and Pediatricians

Health Reform and the AAP: What the New Law Means for Children and Pediatricians Health Reform and the AAP: What the New Law Means for Children and Pediatricians Throughout the health reform process, the American Academy of Pediatrics has focused on three fundamental priorities for

More information

Health Reimbursement Arrangement (HRA).

Health Reimbursement Arrangement (HRA). Retiree benefits 1 Retiree benefits Health Reimbursement Arrangement (HRA). Benefits for Union Pacific s Medicare-eligible retirees and their Medicare- eligible spouses and/or dependents. 2 Union pacific

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 9.0 June 22, 2015 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and international

More information

LCRA Frequently Asked Questions: Medicare Health Plans and Retiree Reimbursement Accounts (RRAs)

LCRA Frequently Asked Questions: Medicare Health Plans and Retiree Reimbursement Accounts (RRAs) LCRA Frequently Asked Questions: Medicare Health Plans and Retiree Reimbursement Accounts (RRAs) Medicare Health and Prescription Drug Plans 1. Q: Do I have to enroll in Medicare Part A and Part B? A:

More information

List of Insurance Terms and Definitions for Uniform Translation

List of Insurance Terms and Definitions for Uniform Translation Term actuarial value Affordable Care Act allowed charge Definition The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%,

More information

52ND LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2015

52ND LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, 2015 SENATE BILL ND LEGISLATURE - STATE OF NEW MEXICO - FIRST SESSION, INTRODUCED BY Linda M. Lopez FOR THE LEGISLATIVE HEALTH AND HUMAN SERVICES COMMITTEE AN ACT RELATING TO HEALTH; ESTABLISHING AN ALL-PAYER

More information

Formulary Management

Formulary Management Formulary Management Formulary management is an integrated patient care process which enables physicians, pharmacists and other health care professionals to work together to promote clinically sound, cost-effective

More information

OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS

OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS Brief Prepared by MATTHEW COKE Senior Research Attorney LEGISLATIVE

More information

Hot Topics in Legislation for Physical Therapy

Hot Topics in Legislation for Physical Therapy This column addresses the legislative and regulatory activity and topics of interest currently being addressed in various jurisdictions. All of the following legislative activity discussed below is current

More information

GOVERNMENTAL AFFAIRS AND LEGAL MATTERS (A)

GOVERNMENTAL AFFAIRS AND LEGAL MATTERS (A) GOVERNMENTAL AFFAIRS AND LEGAL MATTERS (A) 50 Medical Liability Insurance Education for Employed Physicians Introduced by the Fifth and Sixth Districts RESOLVED, That the Medical Society of the State of

More information

REFERENCE ACTION ANALYST STAFF DIRECTOR 1) Insurance, Business & Financial Affairs Policy Committee Reilly Cooper SUMMARY ANALYSIS

REFERENCE ACTION ANALYST STAFF DIRECTOR 1) Insurance, Business & Financial Affairs Policy Committee Reilly Cooper SUMMARY ANALYSIS HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: HB 675 Medicare Supplement Policies SPONSOR(S): Workman and others TIED BILLS: IDEN./SIM. BILLS: REFERENCE ACTION ANALYST STAFF DIRECTOR 1) Insurance, Business

More information

February 2014 Patient Savings Program Use Analysis

February 2014 Patient Savings Program Use Analysis Providing key policy setters and decision makers in the global health sector with unique and transformational insights into healthcare dynamics derived from granular analysis of information. February 2014

More information

It goes by many names: Patient Protection and Affordable Care Act (PPACA) or ACA or Obama Care or simply Healthcare Reform.

It goes by many names: Patient Protection and Affordable Care Act (PPACA) or ACA or Obama Care or simply Healthcare Reform. WHAT IS HEALTHCARE REFORM? Healthcare Reform (HCR) is a law passed by Congress that provides many different requirements. A very important aspect of the law is that it is designed to provide individuals

More information

RETIREE BENEFITS Health Reimbursement Arrangement (HRA).

RETIREE BENEFITS Health Reimbursement Arrangement (HRA). RETIREE BENEFITS 1 RETIREE BENEFITS Health Reimbursement Arrangement (HRA). Benefits for Union Pacific s Medicare-eligible retirees and their Medicare- eligible spouses and/or dependents. 2 UNION PACIFIC

More information

GAO. MEDICARE ADVANTAGE Higher Spending Relative to Medicare Fee-for-Service May Not Ensure Lower Out-of-Pocket Costs for Beneficiaries

GAO. MEDICARE ADVANTAGE Higher Spending Relative to Medicare Fee-for-Service May Not Ensure Lower Out-of-Pocket Costs for Beneficiaries GAO For Release on Delivery Expected at 10:00 a.m. EST Thursday, February 28, 2008 United States Government Accountability Office Testimony Before the Subcommittee on Health, Committee on Ways and Means,

More information

Senate-Passed Bill (Patient Protection and Affordable Care Act H.R. 3590)**

Senate-Passed Bill (Patient Protection and Affordable Care Act H.R. 3590)** Prevention and Screening Services Cost-sharing Eliminates cost sharing requirements for requirements for all preventive services (including prevention and colorectal cancer screening) that have a screening

More information

SUPPLEMENTAL NOTE ON SUBSTITUTE FOR SENATE BILL NO. 11

SUPPLEMENTAL NOTE ON SUBSTITUTE FOR SENATE BILL NO. 11 Corrected SESSION OF 2007 SUPPLEMENTAL NOTE ON SUBSTITUTE FOR SENATE BILL NO. 11 As Amended by House Committee of the W hole Brief* Sub. for SB 11, as amended by the House Committee of the Whole, would

More information

Part D payment system

Part D payment system Part D payment system paymentbasics Revised: October 204 This document does not reflect proposed legislation or regulatory actions. 425 I Street, NW Suite 70 Washington, DC 2000 ph: 202-220-3700 fax: 202-220-3759

More information

Basic Reimbursement - Medicare Part D Specifics

Basic Reimbursement - Medicare Part D Specifics Basic Reimbursement - Medicare Part D Specifics 60889-R8-V1 (c) 2012 Amgen Inc. All rights reserved 2 This information is provided for your background education and is not intended to serve as guidance

More information

Solutions for Today Flexibility for Tomorrow.

Solutions for Today Flexibility for Tomorrow. Solutions for Today Flexibility for Tomorrow. Medicare Products and Services For More Information call our Senior Care Specialist, Raun Lynch at 856.380.5079 Or visit us on the web at www.cbdi-inc.com

More information

NJ CUPA HR The Affordable Care Act & Its Implication for Employers April 4, 2014

NJ CUPA HR The Affordable Care Act & Its Implication for Employers April 4, 2014 NJ CUPA HR The Affordable Care Act & Its Implication for Employers April 4, 2014 About NJBIA Represents 21,000 companies of all sizes and types, which employ over 1 million workers in the State. Advocate

More information

Medicare, VA Health Benefits and TRICARE: What You Need to Know

Medicare, VA Health Benefits and TRICARE: What You Need to Know Medicare, VA Health Benefits and TRICARE: What You Need to Know MMW Coalition Webinar July 31, 2015 AgeOptions 2015. All rights reserved. Who We Are: MMW Leadership AgeOptions Area Agency on Aging (AAA)

More information

SUMMARY OF BENEFITS. Plan 80 - PGB S5755_16SBL_FDH

SUMMARY OF BENEFITS. Plan 80 - PGB S5755_16SBL_FDH 2016 SUMMARY OF BENEFITS Plan 80 - PGB JANUARY 1, 2016 DECEMBER 31, 2016 S5755_16SBL_FDH FE270 UA Medicare Group Part D Prescription Drug Program (PDP) (a Medicare Prescription Drug plan (PDP) offered

More information

Health Care Reform: The Need for Pragmatic, Bipartisan Solutions

Health Care Reform: The Need for Pragmatic, Bipartisan Solutions August 7, 2009 Health Care Reform: The Need for Pragmatic, Bipartisan Solutions For many years, the American people have sent two clear messages about the nation s healthcare system. First, Americans want

More information

Bancorp Insurance Medicare Vocabulary

Bancorp Insurance Medicare Vocabulary Bancorp Insurance Medicare Vocabulary Advance Beneficiary Notice (ABN) A notice indicating the cost of a service that Medicare might not cover. Accepting Assignment Your Doctor agrees to accept payment

More information

The Wellstone-Domenici Mental Health Parity Act Frequently Asked Questions

The Wellstone-Domenici Mental Health Parity Act Frequently Asked Questions The Wellstone-Domenici Mental Health Parity Act Frequently Asked Questions The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was enacted into law on October 3, 2008. This

More information

Massachusetts Health Care Reform and Cancer Care. Therese Mulvey, MD Southcoast Centers for Cancer Care February 2010

Massachusetts Health Care Reform and Cancer Care. Therese Mulvey, MD Southcoast Centers for Cancer Care February 2010 Massachusetts Health Care Reform and Cancer Care Therese Mulvey, MD Southcoast Centers for Cancer Care February 2010 Southcoast Health System in Massachusetts Southcoast Primary and Secondary Markets An

More information

F I S C A L I M P A C T R E P O R T

F I S C A L I M P A C T R E P O R T Fiscal impact reports (FIRs) are prepared by the Legislative Finance Committee (LFC) for standing finance committees of the NM Legislature. The LFC does not assume responsibility for the accuracy of these

More information

Who is your audience?

Who is your audience? Writing a Health Policy Brief A policy brief is an objective analysis of a current and controversial health care cost/access/quality issue directed at a specific audience who is involved in or impacted

More information

2015 Indiana General Assembly

2015 Indiana General Assembly 2015 Indiana General Assembly As of Tuesday: 454 Senate Bills 349 House Bills Budget Full funding of Medicaid forecast $19M - IU medical school campus in Evansville $8M Enhance awareness and provide prenatal

More information

Accountable Care Organization Workgroup Glossary

Accountable Care Organization Workgroup Glossary Accountable Care Organization Workgroup Glossary Accountable care organization (ACO) a group of coordinated health care providers that care for all or some of the health care needs of a defined population.

More information

www.booneinsuranceassociates.com Copyright by BIA 1 MEDICARE MADE SIMPLE BIA 1/14/2016 Boone Insurance Associates Education Guide: New

www.booneinsuranceassociates.com Copyright by BIA 1 MEDICARE MADE SIMPLE BIA 1/14/2016 Boone Insurance Associates Education Guide: New www.booneinsuranceassociates.com Copyright by 1 MEDICARE MADE SIMPLE Boone Insurance Associates Education Guide: New Today s Agenda 2 About Introduction & History of Medicare Medicare Parts A, B, C, D

More information

MENDOCINO COUNTY 2010 HEALTH CARE BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS Questions and Answers

MENDOCINO COUNTY 2010 HEALTH CARE BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS Questions and Answers MENDOCINO COUNTY 2010 HEALTH CARE BENEFITS FOR MEDICARE-ELIGIBLE RETIREES AND DEPENDENTS Questions and Answers Q. Why the change? A. Anticipated exhaustion of the retiree health reserves by the end of

More information

Understanding the Affordable Care Act

Understanding the Affordable Care Act Understanding the Affordable Care Act The Affordable Care Act (officially called the Patient Protection and Affordable Care Act) is the law that mandates that everyone in the United States maintain health

More information

Side-by-Side Comparison of the Senate and House Mental Health Parity Bills Updated September 14, 2007

Side-by-Side Comparison of the Senate and House Mental Health Parity Bills Updated September 14, 2007 Side-by-Side Comparison of the Senate and House Mental Health Parity Bills Updated September 14, 2007 Issue 1. Definition of mental health benefits subject to parity requirement Defines mental health benefits

More information

Mandated Benefit Review of SB 1070: An Act to Relative to Oral Cancer Therapy

Mandated Benefit Review of SB 1070: An Act to Relative to Oral Cancer Therapy Commonwealth of Massachusetts Deval L. Patrick Governor Timothy P. Murray Lieutenant Governor Mandated Benefit Review of SB 1070: An Act to Relative to Oral Cancer Therapy JudyAnn Bigby, M.D. Secretary

More information

Teachers Retirement Insurance Program

Teachers Retirement Insurance Program Comparison of Illinois State Retiree Health Insurance Options with Traditional Medicare and Medicare Supplement (Medigap) Insurance Teachers Retirement Insurance Program Insuraprise, Inc. (C) Copyright

More information

SOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS

SOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS July 19, 2010 Contact: Stacey Pogue, pogue@cppp.org SOMETHING OLD, SOMETHING NEW: TEXAS TWO HIGH-RISK POOLS Thanks to national health reform, Texas now has two separate high-risk pools that offer health

More information

MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016

MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016 PO Box 350 Willimantic, Connecticut 06226 (860)456-7790 (800)262-4414 1025 Connecticut Ave, NW Suite 709 Washington, DC 20036 (202)293-5760 MEDICARE PART D PRESCRIPTION DRUG COVERAGE 2016 Se habla español

More information

Statement Of. The National Association of Chain Drug Stores. For. U.S. Senate Special Committee on Aging. Hearing on:

Statement Of. The National Association of Chain Drug Stores. For. U.S. Senate Special Committee on Aging. Hearing on: Statement Of The National Association of Chain Drug Stores For U.S. Senate Special Committee on Aging Hearing on: 10 Years Later: A Look at the Medicare Prescription Drug Program 2:30 p.m. 366 Dirksen

More information

Welcome to Kaiser Permanente

Welcome to Kaiser Permanente Welcome to Kaiser Permanente Presenting Medicare 101 and Kaiser Permanente Senior Advantage (HMO) Fresno Unified School District Yolanda Smith Retiree Consultant September 2014 Basics of Medicare What

More information

August 2015. AmeriCorps VISTA Healthcare FAQs

August 2015. AmeriCorps VISTA Healthcare FAQs August 2015 AmeriCorps VISTA Healthcare FAQs AmeriCorps VISTA Healthcare FAQs The Affordable Health Care Act (ACA) reformed healthcare and ensures that essential healthcare benefits are made available

More information

Prescription Drug Benefits

Prescription Drug Benefits Prescription Drug Benefits This insert will accompany the Medicare- Coordinating Plans Member Handbook for enrollees who are eligible for and have elected these benefits. Important Notice... 1 Using Your

More information

11 LC 28 5349 A BILL TO BE ENTITLED AN ACT

11 LC 28 5349 A BILL TO BE ENTITLED AN ACT Senate Bill 215 By: Senator Hill of the 32nd A BILL TO BE ENTITLED AN ACT 1 2 3 4 5 6 7 8 9 To amend Title 49 of the Official Code of Georgia Annotated, relating to social services, so as to convert Medicaid

More information

PHA s Insurance Guide

PHA s Insurance Guide INSURANCE GLOSSARY OF TERMS Welcome to our Insurance Guide: Glossary of Terms edition! Use this resource to decipher common insurance vocabulary mysteries. Affordable Care Act (ACA) - the comprehensive

More information

Medicare Supplemental Insurance (Medigap)

Medicare Supplemental Insurance (Medigap) Medicare Supplemental Insurance (Medigap) All Medigap s A through N The available supplemental insurance plans that are offered are lettered plans A-N. Each plan offers a different benefits package and

More information

Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE

Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE Laurus Strategies Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE The Affordable Care Act (ACA) requires non grandfathered health insurance plans in the individual and

More information

Wisconsin typically ranks among the states with the highest level of health

Wisconsin typically ranks among the states with the highest level of health Health Insurance Marketplace in Wisconsin by Wisconsin Office of the Commissioner of Insurance Staff Wisconsin typically ranks among the states with the highest level of health care coverage for its citizens.

More information

Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant

Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Medicaid Topics Impact of Medicare Dual Eligibles Stephen Wilhide, Consultant Issue Summary The term dual eligible refers to the almost 7.5 milion low-income older individuals or younger persons with disabilities

More information

L E G I S L A T I V E A N A L Y S T S O F F I C E. Assembly Judiciary Committee Hon. Bob Wieckowski, Chair

L E G I S L A T I V E A N A L Y S T S O F F I C E. Assembly Judiciary Committee Hon. Bob Wieckowski, Chair September 29, 2014 Proposition 46: Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. L E G I S L A T I V E A N A L Y S T S O F F I C E Presented to: Assembly Health Committee Hon. Richard

More information

Click this button to place your order.

Click this button to place your order. Medicare 33rd Edition 2016 What you need to know about Medicare in simple, practical terms. Click this button to place your order. 2016 MEDICARE CONTENTS 1 2 3 4 5 6 Published By PAGE INTRODUCTION Are

More information

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation

More information

Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy.

Coinsurance A percentage of a health care provider's charge for which the patient is financially responsible under the terms of the policy. Glossary of Health Insurance Terms On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. When making decisions about health coverage, consumers should

More information

American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, Maryland 20852

American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, Maryland 20852 American Kidney Fund 6110 Executive Boulevard Suite 1010 Rockville, Maryland 20852 301.881.3052 voice 301.881.0898 fax 800.638.8299 toll-free 866.300.2900 Español www.kidneyfund.org Member: CFC 11404 December

More information

A Bill Regular Session, 2015 SENATE BILL 133

A Bill Regular Session, 2015 SENATE BILL 133 Stricken language would be deleted from and underlined language would be added to present law. 0 State of Arkansas 0th General Assembly As Engrossed: S// S// A Bill Regular Session, SENATE BILL By: Senator

More information

Medicare Part D Prescription Drug Coverage

Medicare Part D Prescription Drug Coverage Medicare Part D Prescription Drug Coverage Part 3 Version 6.0 September 25, 2012 Terms and Conditions This training program is protected under United States Copyright laws, 17 U.S.C.A. 101, et seq. and

More information

The Impact of Healthcare Reform on Family Caregivers

The Impact of Healthcare Reform on Family Caregivers The Impact of Healthcare Reform on Family Caregivers A Program of National Family Caregivers Association National Alliance for Caregiving Family Caregiver Alliance Overview The Patient Protection and Affordable

More information

5 Mistakes to Avoid MAKE NO MISTAKES MEDICARE WEBINAR: Thinking that Medicare has four parts. www.65incorporated.com

5 Mistakes to Avoid MAKE NO MISTAKES MEDICARE WEBINAR: Thinking that Medicare has four parts. www.65incorporated.com MAKE NO MISTAKES MEDICARE WEBINAR: 5 Mistakes to Avoid MISTAKE #1: Thinking that Medicare has four parts. Medicare has three parts that go together into two paths. 1. The three parts of Medicare:» Part

More information

Health Insurance and Cancer Drug Reimbursement

Health Insurance and Cancer Drug Reimbursement Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Health Insurance and Cancer Drug Reimbursement Michael Kolodziej, M.D., FACP National Medical Director, Oncology

More information

Supreme Court upholds the Affordable Care Act in its entirety:

Supreme Court upholds the Affordable Care Act in its entirety: Supreme Court upholds the Affordable Care Act in its entirety: What does this mean for Seniors? The Supreme Court s decision to uphold the Affordable Care Act (ACA) in its entirety is a huge victory for

More information

Pharmaceutical Marketing & Economic issues: Drug copay subsidies ( coupons ) and potential consumer and State interests

Pharmaceutical Marketing & Economic issues: Drug copay subsidies ( coupons ) and potential consumer and State interests Pharmaceutical Marketing & Economic issues: Drug copay subsidies ( coupons ) and potential consumer and State interests Wells G. Wilkinson Staff Attorney, Community Catalyst Director, Prescription Access

More information

The Health Care Law: How It Can Help People With Cancer and Their Families

The Health Care Law: How It Can Help People With Cancer and Their Families The Health Care Law: How It Can Help People With Cancer and Their Families The new health care law can help save lives from cancer. Learn how it could help you and the people you love. America has some

More information

HOUSE OF REPRESENTATIVES STAFF ANALYSIS REFERENCE ACTION ANALYST STAFF DIRECTOR

HOUSE OF REPRESENTATIVES STAFF ANALYSIS REFERENCE ACTION ANALYST STAFF DIRECTOR HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: HB 371 CS Cancer Drug Donation Program SPONSOR(S): Harrell TIED BILLS: IDEN./SIM. BILLS: SB 1310 REFERENCE ACTION ANALYST STAFF DIRECTOR 1) Health Care General

More information

Medicare Part D. MMA establishes a standard Part D drug benefit, which consists of four components or phases.

Medicare Part D. MMA establishes a standard Part D drug benefit, which consists of four components or phases. Medicare Part D The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) added voluntary prescription drug coverage to Medicare, the federal health insurance program for seniors

More information

HEALTH INSURANCE EXCHANGE FAQS

HEALTH INSURANCE EXCHANGE FAQS HEALTH INSURANCE EXCHANGE FAQS 0 TABLE OF CONTENTS INTRODUCTION... 1 BACKGROUND... 1 HEALTH INSURANCE EXCHANGE FAQS... 1 1 INTRODUCTION IN EARLY 2010, CONGRESS PASSED THE PATIENT PROTECTION AND AFFORDABLE

More information

The Affordable Care Act. What does it mean for you and how we advocate for it?

The Affordable Care Act. What does it mean for you and how we advocate for it? The Affordable Care Act What does it mean for you and how we advocate for it? Who are Young Invincibles? Agenda Overview of the ACA How does health insurance work? What s included in a health insurance

More information

The Discount Drug Card

The Discount Drug Card Medicare Prescription Drug, Improvement, and Modernization Act of 2003 The Discount Drug Card January 2004 Background The Medicare Prescription Drug Discount Card and Transitional Assistance Program was

More information

HEALTH REFORM and VACCINES: Review of Federal Legislation

HEALTH REFORM and VACCINES: Review of Federal Legislation HEALTH REFORM and VACCINES: Review of Federal Legislation The Patient Protection and Affordable Care Act (PPACA) And The Health Care and Education Reconciliation Act Alexandra Stewart June 2, 2012 1 Presentation

More information

Day-to-Day Know Your Health Insurance Coverage

Day-to-Day Know Your Health Insurance Coverage Day-to-Day Know Your Health Insurance Coverage Having good health insurance is important but understanding or choosing your health insurance is not easy. This pamphlet gives you information and lists questions

More information

MEDICARE. Understanding the basics of the Medicare Program.

MEDICARE. Understanding the basics of the Medicare Program. MEDICARE 101 Understanding the basics of the Medicare Program. Table of Contents 01. 05. 13. 17. 25. 29. The History of Medicare What is Medicare? Who is Eligible? Medigap Plans Medicare Advantage (MA)

More information

History of the Older Americans Act

History of the Older Americans Act History of the Older Americans Act Chronological Evolution of National Older American Act Programs and State of Oregon Programs 1920 The Civil Service Retirement Act provided a retirement system for many

More information

The Honorable Alphonso Maldon, Jr. Chairman Military Compensation and Retirement Modernization Commission P. O. Box 13170 Arlington, Virginia 22209

The Honorable Alphonso Maldon, Jr. Chairman Military Compensation and Retirement Modernization Commission P. O. Box 13170 Arlington, Virginia 22209 The Honorable Alphonso Maldon, Jr. Chairman Military Compensation and Retirement Modernization Commission P. O. Box 13170 Arlington, Virginia 22209 Dear Chairman Maldon: The National Association of Chain

More information

HEALTH CARE SYSTEMS ELECTION 2012 ISSUE PAPER NO. 3 SEPTEMBER 2012. Where Are We Now?

HEALTH CARE SYSTEMS ELECTION 2012 ISSUE PAPER NO. 3 SEPTEMBER 2012. Where Are We Now? ELECTION 2012 HEALTH CARE SYSTEMS ISSUE PAPER NO. 3 SEPTEMBER 2012 Vermont League of Cities and Towns 89 Main Street, Suite 4, Montpelier, VT 05602 (802) 229-9111 or (800) 649-7915 info@vlct.org Where

More information

Alzheimer s Impact on the American People and the Economy

Alzheimer s Impact on the American People and the Economy www.alz.org Public Policy Office 202 393 7737 p 1212 New York Avenue, NW 866 865 0270 f Suite 800 Washington, DC 20005-6105 Testimony of Harry Johns, President and CEO of the Alzheimer s Association Fiscal

More information

Choosing a Medicare prescription drug plan.

Choosing a Medicare prescription drug plan. Choosing a Medicare prescription drug plan. Medicare Made Clear TM Get Answers Series Look inside to: Learn about Part D prescription drug coverage options Find out what you need to know about the Part

More information

January 18, 2012. Dear Ms. Tavenner:

January 18, 2012. Dear Ms. Tavenner: January 18, 2012 Marilyn Tavenner, RN, BSN, MHA Acting Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services 200 Independence Avenue, SW Washington, D.C. 20201

More information

Senate Bill No. 2 CHAPTER 673

Senate Bill No. 2 CHAPTER 673 Senate Bill No. 2 CHAPTER 673 An act to amend Section 6254 of the Government Code, to add Article 3.11 (commencing with Section 1357.20) to Chapter 2.2 of Division 2 of the Health and Safety Code, to add

More information

15 HB 429/AP A BILL TO BE ENTITLED AN ACT

15 HB 429/AP A BILL TO BE ENTITLED AN ACT House Bill 429 (AS PASSED HOUSE AND SENATE) By: Representatives Stephens of the 164 th, Wilkinson of the 52 nd, Shaw of the 176 th, Dollar of the 45 th, Rogers of the 29 th, and others A BILL TO BE ENTITLED

More information