Keeping Up Momentum for Patient Access

While 2020 has brought a lot of uncertainty – including early closure of legislatures in the spring and new, virtual formats for hearing and advocacy days – the National Psoriasis Foundation (NPF) and our advocates have not skipped a beat in our work to elevate the patient voice and our mission. Every year in August and September, the NPF advocacy team stops to take stock of the previous year and make plans for the following. This year was no different, but instead of huddling in a conference room we stared into our computer cameras from home.

What’s on the Horizon?  

The 2021 legislative session will provide unique challenges, including uncertainty about the impact of COVID-19 on state budgets, health care and competing priorities. State legislatures are also grappling with the best way to hold public hearings and legislative meetings in a virtual world. Regardless of the challenges of 2021, NPF will continue to focus on removing barriers to care for people with psoriatic disease, and our momentum from advocacy efforts in 2020 will set us up for a successful session in our priority states as well as federally. To make our voices stronger, NPF also partners with other patient and provider organizations through the State Access to Innovate Medicines Coalition (SAIM).

Our top two priorities for 2021 will continue to be step therapy reform and reducing out-of-pocket costs, both of which continue to significantly impact people with psoriasis and psoriatic arthritis. Despite COVID-19, we celebrated step therapy victories in Louisiana, North Carolina and South Dakota this year. In 2021, NPF is partnering with members of the SAIM coalition to build on past successes and continue passing step therapy reform in more states, including leading advocacy efforts in Maryland, Nebraska and Oregon. 

NPF is also prioritizing expanding access to telehealth to ensure our patients have access to their health care providers during the public health emergency and beyond. NPF recently partnered with 34 patient advocacy organizations to develop Telehealth Policy Principles that will guide these advocacy efforts.

Strategies to Reduce Out-of-Pocket Costs

With recent trends shifting the cost-sharing onto patients, and with the financial strains families are facing due to COVID 19, NPF is working to lower out-of-pocket costs through multiple policy strategies.

There are many policy solutions to reduce out-of-pocket costs, with each state taking an approach that matches their health care system and existing laws. Because studies have shown that medication adherence increases following the reduction or complete removal of patient cost sharing for chronic disease prescriptions, NPF supports policies that reduce or remove cost sharing.

Over the last year, some states have addressed high out-of-pocket costs through the creation of Standard Plans, including New Mexico, Maine and Washington state. These plans attempt to strike a balance between cost and affordability for patients, providers and insurance carriers. This includes balancing premiums with cost-sharing for medical services and pharmacy benefits.  

Another approach to lowering out-of-pocket costs is creating “copay-only” plans, a move New Jersey made in 2020. The new law requires 25 percent of exchange plans have a copay-only structure and that no more than 50 percent of the drugs on a carrier’s formulary that are used to treat a specific condition can be placed on the highest cost tier. In other words, the out-of-pocket costs for a treatment must be a flat rate (copay) instead of a percentage (coinsurance).

There has also been a rise in legislation to address copay accumulator programs by requiring all payments made by or on behalf of a patient to count toward their deductible and out-of-pocket maximum. The rise of legislation on this issue in the states comes after rulemaking by the Department of Health and Human Services that leaves decisions about these programs to individual states. To date, five states (Illinois, Virginia, West Virginia, Arizona and Georgia) have passed laws requiring that all copays count. We expect multiple states to take up this issue in 2021.

A focal point of the 2021 legislative session will be addressing out-of-pocket costs through these various policy solutions. NPF will be tirelessly working to ensure we elevate the patient’s voice as these discussions move forward.