Golden state gains new health care protections

| Melissa Leavitt

Health care coverage in California just got better. Thanks in large part to National Psoriasis Foundation (NPF) efforts, three new laws were passed in California earlier today that will keep prescription costs down and help ensure that patients get the care they need.

Last spring, NPF sent more than 20 volunteers and staff members to the California Capitol in Sacramento for California Lobby Day to push for the passage of these bills. Patients and advocates visited different legislators and talked about how these bills would make a difference to people living with psoriasis.

Those efforts have paid off. The new laws limit the amount of money patients pay for prescriptions and help ensure that patients get the medications their doctors think are best. All three help protect patients’ access to affordable and effective treatments.

Reducing out-of-pocket costs

One of the new laws is a victory for NPF’s Cap the Copay efforts. It will limit the amount of money patients pay out of pocket for their prescriptions. How much patients pay will be determined by their health insurance plan and will range from $150 to $500.

That means that people living in California who have psoriatic disease should pay attention to prescription coverage when selecting a health insurance plan, according Patrick Stone, NPF’s state government relations manager.

“Choosing a gold or silver plan could help California residents save more money in the short term on prescription costs,” Stone said.

Step therapy strides

Stone testified on behalf of NPF in support of this law as well as another of the new laws, which paves the way for doctors to fight step therapy decisions made by insurers. Step therapy, which requires patients to try—and fail to improve on—one or more other medications before taking something different, can stand in the way of patients getting the treatment their doctors prescribe.

“Many patients with complex chronic conditions, such as psoriasis and rheumatoid arthritis, do not always fit a ‘one size fits all’ approach to medication. However, step therapy protocols do not reflect that,” said Krystin Herr, vice president of government affairs and advocacy in the pacific region for the Arthritis Foundation, which joined NPF and other patient advocacy organizations in backing the new laws.

On top of the hardship step therapy imposes on patients, it can also force doctors to spend long hours grappling with insurance companies. “Step therapy takes valuable time away from patient care and, for many, does not lead to better patient outcomes,” Herr said.

Deanna Alarcon, an NPF volunteer with psoriasis and psoriatic arthritis, experienced the problems with step therapy firsthand. After developing a fever and infections while on biologics, her doctor wanted to switch her to an oral drug. However, her insurance company’s step therapy policy forced her to try one more biologic, which gave her a painful allergic reaction. During the long battle with Alarcon’s insurance company to get her the treatment she needed, she was without medication altogether.

Her psoriasis got worse, her fatigue increased, and she felt like she “had been bulldozed with a horrible case of the flu,” she said. “If step therapy wasn’t the path insurance companies chose, this never would have been an issue.”

The new law is a step toward in fixing the step therapy process. It makes it easier for doctors to contest step therapy decisions. Under the new law, doctors now have a uniform appeal process they can follow, similar to the process they already follow to request prior authorization for a prescription drug.

“Getting the right drug at the right time is what this law is all about,” said Jerry Jeffe, public policy director for the California Chronic Care Coalition, which also supported the efforts.

"Many doctors and their staffs spend hours on end dealing with insurance companies, health plans, and Medicaid officials on behalf of their patients when approvals are needed through the step therapy process,” Jeffe said. “The new law will make needed reforms so that doctors can spend more time dealing directly with patients, not with insurance companies.”

Informing doctors and patients of biosimilar substitutions

The third new law also helps Californians get the treatment their doctors prescribe. It ensures that a pharmacist must communicate to patients and their doctors if they switch a biologic drug for a biosimilar. Biosimilars are drugs that are similar, but not identical, to biologics. Click here to read NPF’s position on biosimilar substitution.

Under the new law—in cases when a doctor has not already indicated that a substitution should not be made—if a pharmacist decides to make a substitution, the doctor and patient must both be notified.

NPF continues to push for new laws and policies at the state and federal level that keep medical decisions between the patient and doctor, and protect patients’ access to safe, effective and affordable treatments.

As the success of these laws shows, when patients speak up about their experiences, they can bring about important improvements to the health care system.

Alarcon urges patients to continue fighting for the health care they need.

“If we, the patients who are living with the daily struggle of certain flaws in the medical system, don’t speak out, then how will anything improve or be fixed?” she asked. “Sharing our personal experience puts a face to the issue and can help make a lasting impression and ultimately help so many. We’re all human, and sometimes that’s all it takes to help make a change.”

Want to know what NPF is doing for psoriatic disease patients in other states? Click here to learn more about our advocacy efforts. 

Driving discovery, creating community

For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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