What We Are Trying to Accomplish
A more transparent healthcare system that provides the healthcare consumer with necessary information to make informed decisions. The Affordable Care Act (ACA) is making the cost of care more transparent for consumers living with MS, but additional advocacy and awareness are needed. MS activists can look to address these questions in their advocacy efforts during the next legislative session in their state:
- Are health plans required to notify consumers in writing in advance of a formulary change that would impact the enrollees out-of-pocket cost or ability to access a previously available drug or service?
- Are prior authorization requirements for MS disease-modifying or symptom management medications and imaging services reasonable and easily accessed?
- Do consumers have tools to estimate the cost of care, like access to All-Payer Claims Databases (APCDs) and Cost Calculators?
- Should standards for cost calculators be developed (since these databases are common, but often limited and under-utilized by the public?)
Lack of public information on the price of healthcare services, the paperwork required to attain care, and insufficient notification of benefit changes contribute to the burden of living with MS.
Recent price transparency successes have resulted from supporting state legislation that requires insurers to notify plan members before moving a drug to a different formulary tier or removing a drug from the formulary, such as in Arkansas and Oklahoma.
Happening at the National Level
The Society is continuing to advocate that Congress pass surprise billing protections. The bipartisan and bicameral agreement from the Senate Committee on Health, Education, Labor and Pensions and the House Energy and Commerce Committee would end most surprise bills. Congress should pass this legislation immediately.
We are also pleased to see action from the Administration on surprise billing. As part of legislation to address the COVID-19 pandemic, Congress appropriated additional funds to hospitals and providers. The Administration is requiring those who accept the funds to not surprise bill. While this may prevent some surprise billing in the short term, it is unclear if it would apply to all providers in a hospital that receives the funds because that provider may not be employed by the hospital. The action could also face legal challenges.
Make sure consumers have the information they need to make good healthcare decisions.
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