SAIM Coalition Honors State Lawmakers for Work to Improve Patient Access to Medication

 

Honorees championed legislation to curb high out-of-pocket costs, step therapy

Members of the State Access to Innovative Medicines (SAIM) Coalition today recognized four state lawmakers for their work to pass legislation aimed at improving patient access to prescription medications.

Assemblyman Daniel R. Benson (D-NJ-14) and Representative Mike Huval (R-LA-46) were recognized as ‘2020 Legislators of the Year’. This award is given to one lawmaker in the nation who has gone above and beyond to advance each of the SAIM Coalition’s two legislative policy priorities: step therapy reform and controlling out-of-pocket medication costs.

Assemblyman Benson championed New Jersey Assembly Bill 2431, which ensures that out-of-pocket costs passed on to patients by their insurance company cannot exceed $150 per month for each prescription for up to a 30-day supply. The $150 cap includes coverage in Silver, Gold and Platinum insurance plans and applies a $250 cap for the same time period for those with Bronze plans. After a nearly two-year effort, this bill was signed into law in January 2020.

Representative Huval worked closely with members of the Louisiana healthcare community to update state legislation that puts common sense regulation around the insurance industry practice known as step therapy. Step therapy occurs when a patient’s insurance company requires the patient to try and fail on one or more medications selected by the insurer before being grant coverage for the medication prescribed by the patient’s healthcare provider.

Louisiana was among the first states in the nation to pass step therapy reform more than a decade ago. Representative Huval’s legislation (HB 263), which was signed into law in June 2020, updated that law to give stronger protections to patients.

Additionally, two lawmakers were recognized with SAIM’s ‘Patient Access Champion Awards’ for their work on step therapy reform.

In Louisiana, Senator Fred Mills (LA-22) partnered with Representative Huval to pass HB 263, which is seen as one of the strongest step therapy reform laws in the country.

Massachusetts Senator Julian Cyr (D-MA-Cape and Islands), championed S.1235 which passed out of the state Senate in August and is expected to be re-introduced in 2021.

“Patients who face high out-of-pocket costs or other barriers to care such as step therapy are more likely to have worse outcomes, causing additional health concerns for them, and a potentially larger financial burden on the healthcare system, said Brian Henderson, director,  state government affairs, Coalition of State Rheumatology Organizations and co-chair, SAIM Coalition. “When patients have timely, affordable access to medication, all stakeholders win.”

The success of these bills is particularly notable in 2020, with the logistical challenges that the COVID-19 pandemic caused state legislatures.

“Reducing barriers to access to prescription medications is incredibly important for not only the health of our patients, but the stability and effectiveness of the healthcare system as a whole,” said Catherine Peters, director, state and local campaigns, American Cancer Society Cancer Action Network. “SAIM Coalition members work each day with patients who are facing high out-of-pocket costs or step therapy. The work that these lawmakers have done to reduce that burden is to be commended and we look forward to working with them in the future on other patient-friendly legislation.”