Increasing Patient Access to Oral Rx Cancer Treatments in California August 28, 2015 Hosted By:

Transcription

1 Increasing Patient Access to Oral Rx Cancer Treatments in California August 28, 2015 Hosted By:

2 Welcome and Introductions Thea Zajac, Director of Government Affairs, Leukemia & Lymphoma Society Meghan Buzby, Senior Director of Advocacy, International Myeloma Foundation Angela Blanchard, Political Solutions (Representing Komen) Autumn Ogden, Director of State Legislation, American Cancer Society Cancer Action Network

3 Housekeeping Audio: Click the Meeting Info Tab To ask a question, please use the chat function on the bottom right of your screen, make sure to send the question to everyone Or you can also Kimberlee.Theis@lls.org We will post the slides and a recording of the presentation at: speac.myeloma.org

4 Presentation Overview 1. Issue Overview and National Context (Meghan) 2. History of California Bill Passage (Angela) 3. Who Benefits From This Legislation? (Autumn) 4. What To Do If You Still Have High Co- Pays? (Thea)

5 The Problem: Patients Taking Oral Anticancer Medications Pay Much More for Treatment Medical Benefit: IV treatments, inpatient. Copays, avg. $15-$25. Pharmacy Benefit: Oral therapies, out patient. Coinsurance, up to 50%, total cost of medication.

6 The Solution: California Joining Ranks to Provide Affordable Access 40 States & District of Columbia

7 AB 219 Oral Anti-Cancer Rx Cap Saving Lives & Improving Quality of Life for Cancer Patients October 9, 2013 AB 219 was signed into law by Governor Jerry Brown. January 1, 2015 AB 219 went into effect, Increasing access for thousands of Californians to best treatments.

8 AB 219 Oral Anti-Cancer Rx Cap Establishes Fairness in Patient Out-of-Pocket Costs Limits Patient Costs Sets monthly limit of $200 for oral anticancer medications. Not A Mandate Oral Therapies Wave of Future Did not create new benefit, simply leveled playing field for all cancer patients. As much as 30% of new cancer treatments coming in pill form.

9 AB 219 Oral Anti-Cancer Rx Cap Who Benefits From This Legislation? Consumers with state-regulated insurance plans. Including: Large and small group plans Individual plans Plans purchased on Covered California HSA plans (after deductible is met)

10 AB 219 Oral Anti-Cancer Rx Cap What Types of Plans Are Not Impacted By This Legislation? Consumers with federally-regulated insurance plans. Including: Large group ERISA plans Medicare State-run health care programs (Medi- Cal, AIM, PERS)

11 How Was AB 219 Implemented? California has 2 insurance regulation agencies: Department of Managed Health Care Department of Insurance Agencies rely on complaint-based model of investigation. If they don t hear from consumers, then they don t know there is an issue.

12 Consumer Survey Do consumers know where to go? 1 in 4 privately insured Californians face surprise medical bills bills where the insurer paid less than expected The overwhelming majority of Californians (85%) did not know which state agency is tasked with handling complaints about health insurance. More than 2/3 of Californians (71%) were unaware of their right to appeal to the state or an independent medical expert Source: Consumer Reports National Research Center, 2015

13 High Out-of-pocket Rx Copays? Step 1: Try to resolve with the Insurance Carrier Step 2: File a complaint with the appropriate state agency Department of Managed Health Care: Website: Phone: Department of Insurance: Website: Phone:

14 Questions? Type your question into the chat section on the Webinar OR your question to

15 More questions? Feel free to contact us! Thea Zajac Leukemia & Lymphoma Society Angela Blanchard Autumn Ogden American Cancer Society Cancer Action Network Meghan Buzby International Myeloma Foundation Thank you for joining us!