"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Tuesday, April 17, 2012

20 States Limit Drug CoPayments to Protect Patients

According to this FierceHealthPayer article
"Insurers increasingly are facing potential legislation that could prevent them from shifting larger portions of prescription drug costs onto their members.  
At least 20 states have introduced bills to limit insurers charging higher copays for specialty drugs for chronic illnesses."
Why aren't physical therapists doing more to fight this trend in rising physical therapy co-pays?

So far, only KentuckySouth Dakota and New York have created national headlines for their efforts to protect patients from higher copays.

States proposing copay legislation on drug/medication copays are these:
  • New York was the first state to pass a law in 2012, essentially prohibiting insurers from charging higher copays to patients.
  • Vermont has a one-year moratorium on copays that's in effect until July 1, 2012.
  • Maine limits insurers from charging more than $3,500 a year for fourth-tier drug copays.
  • Louisiana and Texas bar insurers from raising out-of-pocket drug costs in the middle of a contract year.
  • Connecticut, Rhode Island and Delaware are considering similar bills in 2012.
Insurance companies previously used "drug price tiers" that shifted low price generic drugs onto the first tier to encourage patients to use these drugs before choosing expensive, brand name drugs. But, insurers have...
"...altered their benefit structures to shift specialty drug costs onto their chronically ill members, causing patients to pay an extra 30 percent to 50 percent for medications..."
When an isurance company changes a drug tier or changes a physical therapy copay, the company purchasing insurance for its employees is expected to give notice to the employees.
"Any time an employer makes a change, we expect that the employer is communicating with their employees, and we follow up with documentation that spells out very clearly the changes made." said Brad Kieffer, Health Net communications director in The Lund Report.
But, busy people often don't pay attention to seemingly minor changes in employer-sponsored benefits, especially when they're still healthy.

The employee may not notice the change until they need healthcare and they show up at their doctor, pharmacist of physical therapist who says to them, "Your copay is $50 per vist".

Then, its too late.

We need to act now - follow the successful lead of Kentucky, South Dakota and New York and encorage your state-level professional organization to propose copayment legislation in 2013.

Partner with the pharmacy associations in your state and propose a combined Drug/PT Copay act that protects patients from rising copayments.

Make comments to this blog and let us know how your actions are working.

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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