Ways To Help

www.lls.org/waystohelp

The Word:

donate

State Policy Documents

This page will contain policy documents about state specific legislation or regulation. The page will be updated as more state documents become available.

Insurance Marketplace Scorecard

This scorecard is a tool to help you evaluate qualified health plans in the insurance marketplace, and ensure the plan you select includes the appropriate combination of essential health benefits and benefit designs to guarantee access to the full range of cancer therapies and services. Click here to download.

Oral Chemo Parity Landscape

This map shows all of the states that have either passed Oral Parity legislation or have a bill pending in 2013. Click here to download.

New York:

The Leukemia & Lymphoma and Myeloma Research, Education, and Treament Program Memo (S.1976/A.558)

The Leukemia, Lymphoma and Myeloma Research, Education and Treatment Program (S.1976/A.558) would promote and fund research, education and treatment programs designed to assist those diagnosed with blood cancer in New York State. Additionally, this legislation would place a "check-off box" on both individual and corporate income tax returns to allow New Yorkers to contribute to the support of this important program.

Maryland:

Step Therapy Testimony (SB746)

An LLS advocate, Ms. Dorothy Spriggs, testified before the Maryland Senate Finance committee in support of legislation that would limit the duration of a step therapy of fail first protocol imposed by a specified insurer, nonprofit health service plan, or health maintenance organization. This means that patients would be able to get the treatment that their doctors want to prescribe covered by their insurance faster, instead of having to go on other treatment regimes first and fail those before getting the doctors preferred treatment.

Specialty Tiers (SB874)

"Medical expenses are contributing factors in more than 60% of personal bankruptcy filings. In some cases, a coinsurance can run into the thousands of dollars each month, exposing the patient to a significant financial hardship and, in some cases, an insurmountable barrier to care.


The adverse effects of such high cost-sharing are not limited to patient finances; these costs have also been shown to discourage adherence to treatment.ii In fact, in a recent study, patients facing high cost-sharing for their medications were found to forgo some more expensive therapies altogether or to discontinue treatments. Unfortunately, poor adherence can lead to poor health outcomes and to an increase in longerterm costs associated with treating disease progression and/or other complications. A study from the New England Health Institute recently estimated that medication non-adherence results in up to $290 billion annually in increased medical costs in the U.S.iii Clearly, this works against the cost-containment goals
that insurers cite as the rationale for their specialty tiers pricing structures.Medical expenses are contributing factors in more than 60% of personal bankruptcy filings. In some cases, a coinsurance can run into the thousands of dollars each month, exposing the patient to a significant financial hardship and, in some cases, an insurmountable barrier to care. The adverse effects of such high cost-sharing are not limited to patient finances; these costs have also been shown to discourage adherence to treatment. In fact, in a recent study, patients facing high cost-sharing
for their medications were found to forgo some more expensive therapies altogether or to discontinue treatments. Unfortunately, poor adherence can lead to poor health outcomes and to an increase in longerterm costs associated with treating disease progression and/or other complications. A study from the New England Health Institute recently estimated that medication non-adherence results in up to $290 billion annually in increased medical costs in the U.S Clearly, this works against the cost-containment goals that insurers cite as the rationale for their specialty tiers pricing structures."

Oral Parity (SB641)

"Innovative, targeted patient-administered medicines have become more prevalent in cancer treatment and are now the recognized standard of care for many types of cancers. Approximately one-quarter of all cancer drugs currently under development are oral (or other patient-administered treatments) and there is an increasing trend toward advances of these therapies. While this original bill was being debated in 2012, the federal government was in the process of debating what would be considered a mandate under the essential health benefits package. Due to this ambiguity, the administration included an amendment where this legislation would not apply to any plans complying with essential health benefits (EHB). All individual and small group plans must comply with essential health benefits, so unfortunately, this exemption left out the majority of consumers with state regulated health plans.Innovative, targeted patient-administered medicines have become more prevalent in cancer treatment and are now the recognized standard of care for many types of cancers. Approximately one-quarter of all cancer drugs currently under development are oral (or other patient-administered treatments) and there is an
increasing trend toward advances of these therapies. While this original bill was being debated in 2012, the federal government was in the process of debating
what would be considered a mandate under the essential health benefits package. Due to this ambiguity, the administration included an amendment where this legislation would not apply to any plans complying with essential health benefits (EHB). All individual and small group plans must comply with essential health
benefits, so unfortunately, this exemption left out the majority of consumers with state regulated health plans."

California:

Letter to the California Health Benefit Exchange

This letter, and many others, were sent to the California Health Benefit Exchange to comment on the proposed Standard Plan Benefit Design. LLS advocates told the Covered California Board that "metal tiered" plans that have specialty tiers with high co-insurances for cancer medications and only a select number of available drugs per class would hurt California cancer patients.

Massachusetts:

LLS Statement on Specialty Tiers (S477)

"On behalf of the Leukemia & Lymphoma Society and the blood cancer patients we serve throughout the state of Massachusetts, we thank you for the opportunity to submit written testimony on Senate Bill 477. Sponsored by Chairman Petruccelli, this important bill would cap patient cost-sharing amounts for ?specialty tier? drug coverage."

LLS Statement on Step Therapy (S439)

"On behalf of the Leukemia & Lymphoma Society and the blood cancer patients we serve throughout the state of Massachusetts, we thank you for the opportunity to comment on Senate Bill 439, which would create guidelines for the use of step therapy in drug formularies.  Step therapy, also known as ?fail first,? is a widely-used technique that insurers use to control drug costs.  Step therapy requires patients to first try and fail on medications selected by their insurer?based on cost?before a patient is granted coverage for the medication that had been initially prescribed by the patient?s healthcare provider."

Oregon:

Statement on Anti Discrimination (SB 1565)

"I tell this story because CML is just one of many diseases. Dr. Druker is working today on finding better treatments for another type of Leukemia, Acute Mylogenous Leukemia (AML) that has a poor prognosis for those who are diagnosed. Supporting this bill will enable the future Judy?s to gain timely access to new and innovative therapies even when they are very sick and told they have no other options. Coverage can no longer be based on criteria that quantify disease progression and level of physical ability.These types of coverage requirements fail to take into account other significant endpoints and the likelihood of an individual patient responding favorably to a particular treatment based on considerations that are unique to a specific individual with a given diagnosis."

Washington:

Statement on Network Adequacy (SB 6511)

"In addition to the ACA-related requirements, emerging technologies, changes in care delivery and payment models require a transparent mechanism to judge whether health plans have robust provider networks to ensure patient access to evidenced-based medical care. Because many of these innovations (e.g. telemedicine, care coordination) can improve access to and the quality of care, it is critical that regulators and other stakeholders examine and update current standards for network adequacy in new models of care, and the growing trend to address beneficiary access issues via non-face-to-face encounters. As states and the federal government assess and update their requirements for network adequacy, focus must be maintained where it belongs ? ensuring patient access."

Statement on Prior Authorization Reform (SB 6511)

"LLS supports this legislation as a pathway to creating standardized prior authorization that will ensure timely patient access to treatments. Blood cancer patients are increasingly dependent on self administered anti-cancer treatments. These treatments have become the recognized standard of care for many types of
cancer, and for some cancers, may be the only option. Given their complexity and cost, insurers now require a prior authorization process for nearly 93% of oncology agents (Healthcare Research & Analytics,2012)"

 

last updated on Thursday, February 20, 2014
btn_sharethis

Why LLS?

Your gift will be used to fund vital research and support our patient and community services.

Questions? Contact us.

Publications

Publications

A free resource provided by the National Institutes of Health - access more than 20 million biomedical literature citations.

Learn More