WASHINGTON, DC / ACCESSWIRE / August 25, 2023 / Twenty-four organizations representing health care consumers and providers have filed an amicus brief in a federal lawsuit challenging the practices of a company operating an alternative funding program on behalf of employer-sponsored health plans. The civil matter, AbbVie Inc., v. Payer Matrix LLC, is before the U.S. District Court for the Northern District of Illinois, Eastern Division.
Alternative funding programs require consumers with health insurance to obtain charitable or other assistance to access their medically necessary treatments. Patient assistance programs (PAPs) are intended to help underinsured and uninsured individuals, not individuals with commercial insurance, access treatment. However, alternative funding programs require that commercially insured consumers obtain their medication through PAPs, which enables health plans to reduce their prescription drug spending.
The amicus brief, organized by Aimed Alliance, describes alternative funding programs’ harmful impact on patients. According to Ashira Vantrees, Counsel to Aimed Alliance, “PAPs are intended to be a safeguard to ensure that underinsured and uninsured individuals can access what would otherwise be an unaffordable treatment. If these programs continue to be exploited by alternative funding programs, which make PAPs less able to serve the intended individuals, PAPs will eventually cease to exist, threatening the health of all consumers who truly rely on these programs.”
The amicus brief contends that alternative funding programs like the defendant’s may fail to disclose critical information to consumers, interfere with the patient-provider relationship, result in harmful delays in access to treatments, discriminate against low-income individuals, jeopardize the sustainability of PAPs, and constitute unfair and deceptive trade practices.
The plaintiff recently asked the federal court to grant an injunction to limit how the defendant advertises its program and prohibit the defendant from “contacting patients and health care providers and relying on sham specialty drug exclusions to falsely claim that patients no longer have insurance coverage” for medically necessary drugs.
The amicus brief was cosigned by 23 groups including CancerCare, Coalition of State Rheumatology Organizations, Color of Crohn’s and Chronic Illness, Hemophilia Federation of America, HIV and Hepatitis Policy Institute, Infusion Access Foundation, Lupus and Allied Diseases Association, National Bleeding Disorders Foundation (formerly National Hemophilia Foundation), National Consumers League, the AIDS Institute, and Triage Cancer. Read the amicus brief here.
For more information on health insurance industry alternative funding programs, read Aimed Alliance’s “Alternative Funding Programs: The Cost Saving Program That Could Cost You,” available here.
About Aimed Alliance
Established in 2013 and based in Washington, DC, Aimed Alliance is an independent, not-for-profit health policy organization that works to protect and enhance the rights of health care consumers and providers. For more information on Aimed Alliance and its initiatives, go to aimedalliance.org and follow @aimedalliance on X, Instagram, and Facebook.
For more information, contact:
Ashira Vantrees, Esq.
policy@aimedalliance.org
202-349-4089
SOURCE: Aimed Alliance
Last Updated on August 28, 2023 by Aimed Alliance
