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Promoting Unrestricted Patient Access to Specialty Drugs

Arce (PR) Introduced Nov. 19 Annual Meeting (Ratified)

Short Title: Specialty Drug Access

WHEREAS, the National Hispanic Caucus Of States Legislators (NHCSL) was founded in 1989 as nonpartisan with the mission of serve as a catalyst for joint action on issues of common concern, such as housing, immigration, education and healthcare, to all segments of the Hispanics communities; and

WHEREAS, the National Hispanic Caucus Of States Legislators has the Vision to promote effective, equal and culturally appropriate access to healthcare for all, including American people and all other minorities; and

WHEREAS, limitations to treatment, restrictions and barriers to the access and disruption of continuity of health care can result in detrimental life threatening consequences to the individuals who are the most vulnerable and can result in more medical complications and higher health care costs; and

WHEREAS, scientific research shows there are gender, racial and ethnic differences in responses to treatments and limiting access further widens already existing health disparities; and

WHEREAS, specialty drugs are, in general, high-cost, require close medical supervision and monitoring, and are usually prescribed for patients with serious chronic diseases like cancer; and

WHEREAS, insurers often charge different co-payments - the patient's share of the cost of a prescription - for different medications which results in medications being placed in different tiers depending on whether they are generic, brand name preferred, brand name non-preferred, or a specialty drug; and

WHEREAS, the pharmaceutical companies have provided discounts and/or free medications to those who are economically disadvantaged; and

WHEREAS, specialty drugs are often in the highest co-payment tier with the largest out- of-pocket costs, subjecting patients to onerous and discriminatory costs on prescriptions for chronic, life threatening conditions; and

WHEREAS, the National Hispanic Caucus of State Legislators (NHCSL) is made up of 300 Hispanics States Legislators from all states, commonwealths and territories of the United States and is organized to provide a forum for discussion, education and increased communication. Additionally, the NHCSL identifies and proposes legislation and administrative actions to eliminate barriers to achievement of a better quality of life for Hispanics; and

WHEREAS, because the Hispanic population is disproportionately impacted by cancer and other chronic diseases, high co-pays for specialty medications can disproportionately impact a Hispanic patient's access to care and may result in serious harm and unjustified discrimination based on disease or disability; and

WHEREAS, with the passage of the Patient Protection and Affordable Care Act (ACA), concerns about excessive out-of-pocket costs have been partially allayed, but patients in need of specialty drugs may not receive the full benefit of this protection since co- payment caps on essential benefits, and levels of cost-sharing by type of drug, are not established by the law and it is unknown whether they will be established through regulation; and

WHEREAS, unregulated and grandfathered insurers may seek to manage the use of expensive drugs by assigning greater co-pay amounts and percentages to specialty medications; and

THEREFORE BE IT RESOLVED, that because the provisions of the ACA do not specifically or completely address this issue, the NHCSL should promote, support, and encourage addressing excessive out-of-pocket costs for specialty medication by state legislative or regulatory action; and

BE IT FURTHER RESOLVED, that through either the health insurance mandate process or through state authority to certify qualified health plans in health benefit exchanges, plans should be prohibited from creating discriminatory specialty tiers within their drug formularies and from requiring payment of a percentage cost of prescriptions; and

BE IT FINALLY RESOLVED, that the amount of patient cost-sharing should be limited and overall out-of-pocket expenses for enrollees capped, and that additional legislative provisions may be needed to safeguard patient access to specialty medications.


Sponsored by: Senator Luz Z. Arce Ferrer (PR)