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 Kentucky, South 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.

Key Contacts Important for Physical Therapist Advocates

"They'll take your money!" said the Senator.

He laughed as he stepped into the elevator. We joined in the laughter, aware of the power differential he created and agreeing with the truth of his words.

"Everybody's up here in Tallahassee playing defense. Even if you physical therapists have nothing on the table this session you need to stay involved."

He was tutoring us now. We remained silent and nodded respectfully.

I was standing next to my former employee and the current owner of three outpatient physical therapy clinics in Bradenton, Florida. I own one clinic. Together, our combined ages just matched the Senator's age.

The Senator knew us from visits to his office back in the district. He was always cordial but I had seen him show a healthy distrust of medical professionals - his construction business paid heavy workers' compensation premiums every year and Medicaid fraud-busting was his top priority.

Could we persuade him to see physical therapists differently?

"The papers keep saying you will run for one of Florida's two open Congressional seats in 2012?" I said

"My wife wants me to retire - but I'm having a great time!"

The Senator got off the elevator to go to his committee meeting. "See you boys later!" he said over his shoulder.

Being a Key Contact

Physicians have more money than physical therapists and chiropractors have been a political force in Florida for longer than I have been alive.

So, what can physical therapists bring to compete with dollars and political precedence?

Compelling stories and a genuine focus on the patient.

Physical therapists can tell stories about helping people walk after devastating accidents. Or, we can describe simple, safe interventions that enable people to live independently - all without drugs or surgery.

Witness the effect of stories and a genuine patient focus on this improbable political victory by Larry Benz, DPT and a determined grassroots effort in Kentucky:

"Get organized, be bold, and go for it.

PT's don't go in front of legislators very often and when we do we have great patient testimonies, empirical evidence, and a host of intangibles that at the end of the day are easy to understand and resonate with many.

While you can never underestimate the power of the political process, you can prevail."

Physical therapists are not natural political operators - that's what makes us stand out in a positive way in places like Tallahassee.

The Legislature is divided into two houses. The House of Representatives and the Senate make laws that govern Florida. There are 120 members of the House of Representatives and 40 members of the Senate.

We need your help.

If you have considered helping your professional association and you feel that you could share your patients' successful stories or speak up for the profession please contact Eric Chaconas, DPT to be added to the list of Florida's Key Contacts.