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Dual Victories As First Time Chapter Driven Laws Are Enacted In Maine And Vermont

This spring the chapter made history in Maine and Vermont through the enactment of laws to limit out-of-pocket prescription drug expenses for consumers with private insurance. Consumers are increasingly subject to new insurance practices in the form of “specialty tiers” for certain prescription drugs. These tiers impose coinsurance instead of traditional fixed co-payments on expensive specialty drugs like biologics. Consumers using biologics can hardly afford to pay an actual percentage of the total drug cost, and they decide to halt treatment regimens, reduce dosages, or risk financial ruin.

Last year Senator Fox secured a one year moratorium on specialty tiers due to expire July 1, 2012. This session the Vermont Government Relations Committee requested Senator Fox re-file the bill. This session, SB221, co-sponsored by Senator Mullen was merged into H.559, the health care exchange bill. H.559 was enacted into law by Governor Shumlin. The law includes all prescription drugs and sets a beneficiary’s annual out-of-pocket limit for employer sponsored plans at $2,000/individual and $4,000/family. The out-of-pocket limit includes co-payment, coinsurance, deductible, and other cost-sharing mechanisms. The law also precludes insurers from setting a limit on prescription drug benefits.

The Maine Government Relations Committee, with the New England Coalition for Affordable Prescription Drugs, successfully ensured passage of contentious legislation to prohibit the practice of specialty prescription drug tiers. MS activists joined other consumers, presenting powerful testimony to the Joint Committee on Insurance, and gained media coverage. Representatives Susan Morissette and Sharon Treat championed the bill. The bill enacted into law by Governor LePage requires certain insurance carriers who provide prescription drug coverage to add a $3,500/year out-of-pocket limit for consumers. Carriers can still implement or continue to use specialty tiers in their drug formularies.

Vermont Bill signing (L-R): GRC Volunteer Ralph Montefusco, Director of Public Policy, Advocacy Manager Michelle Dickson, Vermont Governor Peter Shumlin, Program Coordinator Shanna McCabe.