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The National MS Society and MS activists advocate at the federal, state and local levels for increased MS research, access to quality care, disability rights, long-term services and supports and awareness and organizational support.

Position: The National Multiple Sclerosis Society urges full expansion of Medicaid pursuant to the Affordable Care Act so that all qualified Georgians have access to affordable, comprehensive health care.

The financial impact of MS on individuals and families can be devastating:
 

  • Multiple Sclerosis (MS) is typically diagnosed between the ages of 20 and 50, when most are raising families, advancing careers, and maximizing their earnings. Yet studies show that only 40% are in the workforce ten years after their diagnosis, and some lost access to employer-based health coverage.
     
  • The average annual cost for someone with MS in the U.S. including both direct and indirect costs (i.e. lost wages) is approximately $69,000. Of this, approximately $39,000 consists of health care costs.
     
  • Seventy percent of persons with MS report difficulty paying for health care, even with health insurance and many are forced to delay doctor visits and split their medication doses or skip them altogether.

Leveraging federal dollars to provide low-income working Georgians health insurance is a smart investment that could provide up to 650,000 Georgians, including people with MS affordable, comprehensive coverage.

 

  • Georgia has one of the highest uninsured rates in the country.  By extending coverage to 650,000 low-income, uninsured residents, Medicaid expansion will help Georgians get preventative services and will improve health outcomes. 
     
  • Medicaid expansion is expected to bring $36 billion in direct federal funds and have a cumulative impact of $72 billion on the Georgia economy over the next 10 years.  Since poor health is the most common reason to miss work, and since medical bills are the leading cause of bankruptcy, Medicaid expansion could also play a role in maintaining the health of the workforce, preventing medical bankruptcies, and even preventing related foreclosures. 

Take a step toward Fairness and Transparency by requiring health plans to notify enrollees of        increases in cost to their prescription drug benefits during the terms of a contract.

People living with MS who depend on prescription medications should be able to rely on their health insurance and the insurer’s drug formulary for the life of the insurance contract.

Health insurance contracts resemble other contracts of adhesion and provide no opportunity for an enrollee to negotiate the bulk of the contract’s terms or option to opt-out during the contract year.  Providing continuity of prescription drug coverage is an essential safeguard that maintains access to vital and often life-saving medicines.

 

HB 644 requires health plans to:
 

  • Notify beneficiaries 90 days prior to moving a drug to a higher tier, removing a drug from a formulary, adding a prior-authorization requirement, imposing quantity limits, or increases in step-therapies; and
     
  • Respond to enrollee’s drug formulary inquiries within three days.

Greater transparency will help individuals budget for the costs of their medications. Unexpected changes to prescription drug costs during the 12-month contract period can create a serious problem for policy holders.  An unexpected increase—especially for expensive prescriptions—can be difficult to absorb, often leaving no option but to stop essential treatment.

 

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