Aimed Alliance Issues Letter of Support for AMA Resolutions on Step Therapy and Copay Accumulators


On November 7, 2019, Aimed Alliance issued a letter of support to the American Medical Association (AMA), voicing support for Resolution 205 and Resolution 815. These resolutions will be considered at the AMA House of Delegates meeting later this month.

If adopted, Resolution 205 would commit the AMA to developing model legislation for copay accumulators that is similar to the law that was recently enacted in Virginia. This law requires health plans to include amounts paid by an enrollee or on their behalf in the calculation of the enrollees out-of-pocket maximum or any other cost-sharing requirement. Aimed Alliance supports this resolution because it prevents health plans from excluding the value of third-party financial assistance from the calculation of an enrollee’s deductible. Without this protection, patients who use third-party financial assistance to fulfill their cost-sharing responsibilities could find that they cannot afford to fill their prescriptions once their financial assistance is exhausted. This can lead to treatment nonadherence or abandonment, disease progression or relapse, and increased health care utilization. Aimed Alliance believes that these types of outcomes should be avoided to ensure that patients can receive the best health outcomes possible and that health care resources are allocated efficiently.

If adopted, Resolution 815 would commit the AMA to extending its advocacy for patient protections from Medicare Advantage plans to all health plans and support state and federal legislation that would allow clinician-initiated exceptions to step therapy protocols. Aimed Alliance supports this resolution because state law does not uniformly protect patients against unreasonable step therapy policies. Additionally, Aimed Alliance believes that federal law could be improved by requiring exception processes in employer-sponsored health plans, which would provide greater certainty to patients that their providers are able to advocate in their best interests when step therapy requirements inhibit their ability to access medically necessary treatments.

To read the full letter, click here.


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