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# Aimed Alliance

## Sitemaps

- [XML Sitemap](https://aimedalliance.org/sitemap.xml): Contains all public & indexable URLs for this website.

## Posts

- [Why Step Therapy Is Failing People With Serious Mental Illness — And What States Are Doing About It](https://aimedalliance.org/why-step-therapy-is-failing-people-with-serious-mental-illness-and-what-states-are-doing-about-it/) - Aimed Alliance’s new resource, "Forced to Fail: The Human Cost of Step Therapy in Mental Health" shines a bright light on a quiet crisis: insurance policies that force people with serious mental illness (SMI) to “fail first” on cheaper medications before getting the treatment their clinicians actually recommend. This new resource highlights patient stories, clinician
- [Aimed Alliance Urges for Increased PBM Transparency](https://aimedalliance.org/aimed-alliance-urges-cms-to-adopt-copay-accumulator-reform/) - On April 15, Aimed Alliance commented on the Department of Labor's "Improving Transparency Into Pharmacy Benefit Manager Fee Disclosure" proposed rule. Aimed Alliance supported the many disclosure requirements included in the proposed rule. In addition, the comment urged for the Department of Labor to require the disclosure of benefit utilization savings; clarify that third-party programs
- [Aimed Alliance Urges for Oversight in 340B Reform](https://aimedalliance.org/aimed-alliance-urges-for-oversight-in-340b-reform/) - On April 13, 2026, Aimed Alliance sent a letter to New York Senator Rivera and Assemblymember Paulin regarding the proposed reforms to the federal 340B drug pricing program. Aimed Alliance's letter urged the Legislature to pursue 340B transparency and reporting requirements that mandate covered entities disclose (1) 340B revenue; (2) how 340B Program revenue is
- [Aimed Alliance Urges NJ to Strengthen PBM Bill to Better Protect Patients and Promote PBM Accountability](https://aimedalliance.org/aimed-alliance-urges-new-jersey-to-strengthen-pbm-bill-to-better-protect-patients-and-promote-pbm-accountability/) - On April 16, 2026, Aimed Alliance sent a letter to New Jersey Assemblywoman Lisa Swain, Chair of the Assembly Appropriations Committee, urging the Committee to strengthen Assembly Bill 1502 to ensure that PBM reform delivers meaningful benefits to patients. While commending New Jersey for its leadership in advancing PBM oversight, the letter explains that additional
- [Aimed Alliance Releases 2025 Annual Report](https://aimedalliance.org/aimed-alliance-releases-2025-annual-report/) - In 2025, Aimed Alliance engaged in a wide variety of activities to protect and enhance the rights of health care consumers and providers, and to ensure that in the growing age of technology and healthcare, patients and providers always remain the priority. We are pleased to share our Annual Impact Report 2025, which highlights the
- [CMS Open Enrollment Report Shows 1.2 Million Fewer Americans Are Insured](https://aimedalliance.org/cms-open-enrollment-report-shows-1-2-million-fewer-americans-are-covered/) - The Centers for Medicare & Medicaid Services (CMS) Health Insurance Exchanges 2026 Open Enrollment Report found that 1.2 million fewer consumers enrolled in coverage during the 2026 open enrollment period (OEP) compared with 2025, representing a 5 percent decline. The report summarizes health plan selections made through the individual insurance Exchanges during the 2026 OEP.
- [Aimed Alliance Comments on 2027 NBPP](https://aimedalliance.org/aimed-alliance-comments-on-2027-nbpp/) - On March 13, 2026, Aimed Alliance commented on the 2027 Notice of Benefit and Payment Parameters (2027 NBPP). In its comment, Aimed Alliance urged the Centers for Medicare & Medicaid Services to take steps to improve health care affordability by banning copay accumulators, clarifying that all drugs covered in addition to the Benchmark Plan should
- [Aimed Alliance Provides Testimony of UPLs Before New Jersey’s PDAC](https://aimedalliance.org/aimed-alliance-provides-testimony-of-upls-before-new-jerseys-pdac/) - On March 19, 2026, Aimed Alliance provided testimony to the New Jersey Prescription Drug Affordability Council, which is developing legislative and regulatory recommendations to address rising prescription drug costs. Aimed Alliance Staff Attorney, Olivia Backhaus, outlined why upper payment limits (UPLs) are unlikely to lower costs for patients, citing other states’ experiences with high administrative
- [Aimed Alliance Submits Comment on FTC’s Proposed Settlement with Express Scripts](https://aimedalliance.org/aimed-alliance-submits-comment-on-ftcs-proposed-settlement-with-express-scripts/) - On March 16, Aimed Alliance submitted a comment on the proposed settlement between the Federal Trade Commission and Express Scripts, IncEvernorth Health, Inc., Medco Health Services, Inc., and Ascent Health Services LLC. Aimed Alliance's comment applauded the settlement provisions that ensured savings pass directly to health care consumers. Aimed Alliance also urged the FTC to
- [Aimed Alliance Pushes Back on PDAB Legislation in Illinois](https://aimedalliance.org/aimed-alliance-pushes-back-on-pdab-legislation-in-illinois/) - On March 18, 2026, Aimed Alliance submitted comments to the Health Care Availability & Accessibility Committee urging caution against Illinois House Bill 1443, which would establish a Health Care Availability and Access Board with authority to set upper payment limits (UPLs) on prescription drugs. Aimed Alliance warned that UPLs may unintentionally restrict patient access, increase
- [Aimed Alliance Urges Amendments to Virginia’s PDAB Bill to Protect Patient Access](https://aimedalliance.org/aimed-alliance-urges-amendments-to-virginias-pdab-bill-to-protect-patient-access/) - On March 13, 2026, Aimed Alliance sent a letter to Governor Abigail Spanberger urging amendments to Virginia’s House Bill 483, which would cap certain prescription drug reimbursements at Medicare’s “maximum fair price.” The letter warned that the H.B. 483 could unintentionally restrict patient access, as upper payment limits (UPLs) may increase utilization management, alter formularies,
- [Administration Targets Foreign Drug Pricing in Upcoming Section 301 Investigation](https://aimedalliance.org/administration-targets-foreign-drug-pricing-in-upcoming-section-301-investigation/) - Recently, the Trump Administration announced plans to initiate a new Section 301 investigation into foreign drug pricing policies, which it argues force Americans to bear an outsized share of the global cost of pharmaceutical innovation. The proposed probe would examine whether U.S. trading partners are paying less than their fair share for prescription drugs. Learn
- [Aimed Alliance Supports CA Copay Accumulator Ban](https://aimedalliance.org/aimed-alliance-support-ca-copay-accumulator-ban/) - Aimed Alliance recently sent a letter to the California legislature urging for the ban of copay accumulator programs. These programs prevent the value of copay assistance from counting toward a patient’s deductible or out-of-pocket maximum, forcing many individuals, especially those managing chronic or rare conditions, to pay thousands of dollars more each year to access
- [FDA Confirms AFPs Not Permissible Under Section 804](https://aimedalliance.org/fda-confirms-afps-not-permissible-under-section-804/) - On August, 28, 2024, Aimed Alliance received an interim response from the Food and Drug Administration regarding its Citizen Petition on alternative funding programs (AFPs) and their use of international importation. On March 27, 2026, the FDA provides a complete response to Aimed Alliance's petition stating that (1) AFPs are not permissible under FD&C Act Section
- [Minnesota Reports $1.34 Billion in 340B Revenue ](https://aimedalliance.org/minnesota-reports-1-34-billion-in-340b-revenue/) - Minnesota’s second year of 340B reporting shows that Covered Entities generated at least $1.34 billion in net 340B revenue in 2024, more than double the $630 million reported in 2023. The 340B Drug Pricing Program allows eligible safety net providers to buy outpatient drugs at a discount while receiving full reimbursement, but the program lacks transparency.
- [Aimed Alliance Urges Maryland PDAB to Protect Patient Access in UPL Deliberations](https://aimedalliance.org/aimed-alliance-urges-maryland-pdab-to-protect-patient-access-in-upl-deliberations/) - Aimed Alliance sent letters to the Maryland PDAB urging it to proceed cautiously with setting a UPL for Jardiance and Farxiga, emphasizing the risk of unintended consequences such as formulary exclusions and harmful non‑medical switching for stable patients. The letters call for robust monitoring mechanisms and clear safeguards to ensure that any UPL does not
- [New Report - International Reference Pricing: Lessons Learned from Abroad](https://aimedalliance.org/new-report-international-reference-pricing-lessons-learned-from-abroad/) - For decades, rising costs of health care, health insurance, and prescription drugs have been a major concern for American consumers, caregivers, providers, and employers. To address these challenges, policymakers are exploring international reference pricing (IRP) models, such as the proposed “Most Favored Nations” (MFN) policy, and more formalized models such as the GENEROUS (GENErating cost Reductions fOr
- [GLOBE Model Expected to Have Minimal Impact on Part B OOP Costs  ](https://aimedalliance.org/globe-model-expected-to-have-minimal-impact-on-part-b-oop-costs/) - A new analysis published by Avalere Health found that the proposed GLOBE (Global Benchmark for Efficient Drug Pricing) Model would have a minimal impact on Medicare Part B beneficiaries’ out-of-pocket (OOP) costs. Introduced by CMS in December 2025, the GLOBE Model would incorporate international reference pricing into Medicare Part B by comparing drug average sales prices to international benchmarks and adjusting rebates
- [Aimed Alliance Published 2025 Gold Card Recap Resource](https://aimedalliance.org/aimed-alliance-published-2025-gold-card-recap-resource/) - Gold card laws exempt healthcare providers from prior authorization if they have a high approval rate, reducing delays in patient care and administrative burdens. These laws aim to streamline access to treatment by allowing providers to bypass burdensome authorization requirements. Since 2022, Aimed Alliance has published an annual Gold Card tool summarizing gold card legislation
- [Aimed Alliance Urges Reconsideration of VA PDAB Bill](https://aimedalliance.org/aimed-alliance-urges-reconsideration-of-va-pdab-bill/) - Aimed Alliance recently sent a letter urging the Virginia House Labor and Commerce Committee to reconsider House Bill 483, which would create a Prescription Drug Affordability Board (PDAB). The letter outlines why upper payment limits set by PDABs do not directly reduce patients’ out‑of‑pocket costs and may even worsen access due to increased utilization management
- [CDC Updates U.S. Childhood Immunization Schedule ](https://aimedalliance.org/cdc-updates-u-s-childhood-immunization-schedule/) - On January 5, the Centers for Disease Control and Prevention (CDC) Acting Director Jim O’Neill announced significant updates to the U.S. childhood immunization schedule. While the CDC continues to recommend immunization against 10 core diseases, plus varicella (chickenpox), for all children, the approach to other vaccines has changed. Instead of recommending every vaccine universally, the
- [Aimed Alliance Publishes Updated 2025 PDAB Resources](https://aimedalliance.org/aimed-alliance-published-updated-2025-pdab-resource/) - Aimed Alliance is pleased to share two new resources on prescription drug affordability boards (PDABs). PDABs are established at the state level and aim to combat the escalating costs of prescription drugs. Due to the diverse approaches taken by different states, Aimed Alliance has updated our 2024 resources to inform advocates and stakeholders on the
- [Congress Unveils SAFE Drugs Act to Address Risks of Compounded Medications ](https://aimedalliance.org/congress-unveils-safe-drugs-act-to-address-risks-of-compounded-medications/) - On December 10, 2025, Representatives Rudy Yakym (R-IN) and André Carson (D-IN) introduced the Safeguarding Americans from Fraudulent and Experimental (SAFE) Drugs Act of 2025, a bipartisan initiative designed to protect patients from untested, unapproved, and potentially dangerous compounded drugs. Compounded drugs, often produced in bulk without oversight and have been linked to adverse events,
- [New Resource Helps Policymakers Protect Consumers from Deceptive AFPs](https://aimedalliance.org/new-resource-helps-policymakers-protect-consumers-from-deceptive-afps/) - Aimed Alliance, the National Bleeding Disorders Foundation and the Hemophilia Alliance, released a new resource, “Protecting Consumers from Unfair and Deceptive Trade Practices,” to help regulators and legislators protect consumers from a business practice known as "alternative funding programs" (AFPs). The resource details how AFPs mislead employees, patients, employers, and patient assistance programs; the harm
- [Trump Administration Must Address the Use of Junk Science](https://aimedalliance.org/trump-administration-must-address-the-use-of-junk-science/) - On December 5, 2025, Aimed Alliance's Counsel, Michael Barnes, published a new opinion piece titled “Trump Administration Took Decisive Action on TikTok — Now Confront Junk Science.” This article argues that the Trump Administration should take swift action in rooting out “junk science” from U.S. courtrooms. The piece highlights how unreliable or cherry-picked expert testimony,
- [Aimed Alliance Publishes New Resource on the USTR and MFN](https://aimedalliance.org/aimed-alliance-publishes-new-resource-on-the-ustr-and-mfn/) - Aimed Alliance has released a new fact sheet explaining the role of the U.S. Trade Representative (USTR) in shaping international trade policy and how its actions increasingly intersect with prescription drug pricing. This new resource highlights USTR’s role in addressing foreign practices that unfairly burden U.S. commerce, including those that may suppress drug prices abroad
- [CMS Launches GENEROUS Model to Lower Medicaid Drug Costs and Expand Access ](https://aimedalliance.org/cms-launches-generous-model-to-lower-medicaid-drug-costs-and-expand-access/) - Earlier this month, the Centers for Medicare & Medicaid Services (CMS) announced a new drug payment initiative aimed at addressing high and rising prescription drug spending in Medicaid. The GENEROUS (GENErating cost Reductions fOr U.S. Medicaid) Model, set to launch in 2026, allows CMS to negotiate with participating manufacturers for lower drug prices, while states
- [First U.S. AI Chatbot Law Grants Families Private Right of Action ](https://aimedalliance.org/first-u-s-ai-chatbot-law-grants-families-private-right-of-action/) - On October 13, 2025, California Governor Gavin Newsom signed Senate Bill 243 into law, establishing the first comprehensive state law specifically regulating “companion chatbots,” AI systems designed to provide adaptive, human-like social interactions. The law requires chatbot operators to implement reasonable safeguards for AI interactions, such as requiring operators to notify minors that they are
- [Colorado Sets Nation’s First UPL, Raising Patient Safeguards Concerns](https://aimedalliance.org/colorado-sets-nations-first-upl-raising-patient-safeguards-concerns/) - On October 3, the Colorado Prescription Drug Affordability Board (PDAB) voted to establish an upper payment limit (UPL) for Enbrel, effective January 1, 2027, making Colorado the first state to implement such a cap. The UPL, set slightly above the Medicare Fair Price at $600 per 50 mg unit, will apply to all purchases and
- [Aimed Alliance Quoted in Fierce Healthcare Article on AFPs](https://aimedalliance.org/aimed-alliance-quoted-in-fierce-healthcare-article-on-afps/) - A new article by Fierce Healthcare titled "A new wave of middlemen offers 'alternative funding' for specialty drugs. Patients bear the risks" highlights the harm patients can experience when being required to work with an alternative funding vendor. After conducting more than four dozen interviews with patients and patient advocates, clinicians, attorneys, pharmaceutical companies, drug
- [Aimed Alliance Urges Wisconsin Lawmakers to Pass SB 203, “Cole’s Act”](https://aimedalliance.org/aimed-alliance-urges-wisconsin-lawmakers-to-pass-sb-203-coles-act/) - Aimed Alliance recently sent a letter to Wisconsin Senators expressing support for SB 203, “Cole’s Act,” which would ban the use of copay accumulator programs in Wisconsin. These programs prevent the value of copay assistance from counting toward a patient’s deductible or out-of-pocket maximum, forcing many individuals, especially those managing chronic or rare conditions, to
- [Aimed Alliance Urges OH Legislators to Pass Copay Accumulator Reform](https://aimedalliance.org/aimed-alliance-urges-oh-legislators-to-pass-copay-accumulator-reform/) - Aimed Alliance recently sent a letter to the Ohio legislature urging for the ban of copay accumulator programs. These programs prevent the value of copay assistance from counting toward a patient’s deductible or out-of-pocket maximum, forcing many individuals, especially those managing chronic or rare conditions, to pay thousands of dollars more each year to access
- [Aimed Alliance Releases New Explainer on 340B Program](https://aimedalliance.org/aimed-alliance-releases-new-340b-explainer/) - On October 22, Aimed Alliance published a new resource on the 340B Drug Pricing Program (340B Program). The 340B program is a federal program designed to help “covered entities” serving low-income and uninsured patients stretch their financial resources by purchasing prescription drugs at substantially discounted prices. In recent years, the 340B Program has come under
- [Aimed Alliance & NORM Release 2026 Open Enrollment Brochures](https://aimedalliance.org/aimed-alliance-norm-release-2026-open-enrollment-brochures/) - The 2026 Open Enrollment period is fast approaching! The 2026 Open Enrollment period for Medicare Advantage plans is October 15, 2025, to December 7, 2025, while the Open Enrollment period of individuals, small group and large group plans on November 1, 2025, to December 15, 2025. To ensure consumers are able to select the health
- [FDA Warns Against Using Unapproved Blood Pressure Apps](https://aimedalliance.org/fda-warns-against-using-unapproved-smartwatch-and-smart-ring-blood-pressure-apps/) - On September 16, 2025, the Food and Drug Administration (FDA) issued a warning that many over-the-counter blood pressure devices lack FDA authorization and may provide inaccurate readings. FDA advised that using unapproved devices can lead to misdiagnosis of high or low blood pressure, delayed or missed treatment, and serious health risks, including stroke, heart attack,
- [Aimed Alliance Urges Stronger Consumer Protections in CO Bill on AFPs](https://aimedalliance.org/aimed-alliance-urges-stronger-consumer-protections-in-colorado-bill-on-alternative-funding-programs/) - Aimed Alliance sent a letter to Colorado Representative Ken DeGraaf regarding his special session bill, "Prescription Drug Benefit Information Transparency" (HB25B-1012). The proposed legislation would have permitted alternative drug sourcing programs and pharmacy stewardship programs and prohibited PBMs, brokers, and health care consultants from making false or misleading statements about these programs. Aimed Alliance urged for
- [Aimed Alliance Calls on FDA to Clarify Mandated Use of Drug Importation Programs ](https://aimedalliance.org/aimed-alliance-calls-on-fda-to-clarify-mandated-use-of-drug-importation-programs/) - On October 7, 2025, Aimed Alliance sent a follow-up letter to the U.S. Food and Drug Administration (FDA) regarding the Aimed Alliance's March 2024 Citizen Petition to the FDA on third-party companies that partner with employer-sponsored health plans to require employees to import prescription drugs from outside the United States through alternative funding programs (AFPs).
- [Aimed Alliance Shares Concerns Regarding Affordability Review Process with Oregon PDAB](https://aimedalliance.org/aimed-alliance-shares-concerns-regarding-affordability-review-process-with-oregon-pdab/) - Aimed Alliance submitted a comment to the Oregon Prescription Drug Affordability Board (PDAB) urging it to maintain a careful, evidence-based approach as it conducts affordability reviews. The letter raises concerns about the Board’s accelerated timeline and the volume of drugs being reviewed at once, warning that rushing could compromise decision quality and public trust, and
- [Aimed Alliance Sends Letter on CO AFP Legislation](https://aimedalliance.org/aimed-alliance-sends-letter-on-co-afp-legislation/) - Aimed Alliance sent a letter to Colorado Representative Ken DeGraaf's regarding his special session bill "Prescription Drug Benefit Information Transparency" (HB25B-1012). The proposed legislation would have permitted alternative drug sourcing programs and pharmacy stewardship programs and prohibited PBMs, brokers, and health care consultants from making false or misleading statements about these programs. Aimed Alliance urged for
- [Aimed Alliance Publishes New PBM Reform Resource](https://aimedalliance.org/aimed-alliance-publishes-new-pbm-reform-resource/) - Aimed Alliance has published a new resource highlighting pharmacy benefit manager (PBMs) practices and proposed reforms to ensure transparency in health care affordability and prescription drug pricing reform. PBMs are powerful middlemen in the health care system that manage prescription drug benefits on behalf of insurers. While PBMs were originally created to streamline pharmacy benefits
- [HHS Launches Voluntary 340B Rebate Pilot for Negotiated Medicare Drugs ](https://aimedalliance.org/hhs-launches-voluntary-340b-rebate-pilot-for-negotiated-medicare-drugs/) - Following a May court ruling that pharmaceutical manufacturers must receive Health Resources and Services Administration (HRSA) approval before replacing upfront 340B discounts with rebates, the Department of Health and Human Services has announced a new voluntary 340B Rebate Model Pilot Program. The Pilot will apply only to drugs included on CMS’ Medicare Drug Price Negotiation List
- [CMS to Launch Pilot AI Model to Reduce Wasteful Medicare Spending](https://aimedalliance.org/cms-to-launch-pilot-ai-model-to-reduce-wasteful-medicare-spending/) - Beginning in January 2026, the Centers for Medicare & Medicaid Services (CMS) will launch the Wasteful and Inappropriate Service Reduction (WISeR) Model to oversee Medicare payments. The initiative will combine advanced technologies, such as Artificial Intelligence (AI) and Machine Learning (ML), to support payment review processes and identify care that may be clinically unsupported. By
- [ACA's Preventative Care Coverage and Religious Freedom](https://aimedalliance.org/acas-preventative-care-coverage-and-religious-freedom/) - Braidwood Management, Inc. et al. v. Robert F. Kennedy, Jr. et al. (formally Braidwood Management, Inc. et al. v. Becerra) Brief Summary: A Federal District Court in Texas struck down the Patient Protection and Affordable Care Act’s (ACA) preventative services coverage requirement relying on both religious and constitutional grounds to permit employers to limit coverage
- [Aimed Alliance Urges Federal Action to Protect ACA Cost-Sharing and Drug Coverage Protections](https://aimedalliance.org/aimed-alliance-urges-federal-action-to-protect-aca-cost-sharing-and-drug-coverage-protections/) - On July 28, Aimed Alliance sent a letter to the Centers for Consumer Information and Insurance Oversight (CCIIO) and the Department of Labor (DOL), urging the agencies to issue new rules clarifying two key issues rules related to cost-sharing and essential health benefits under the Affordable Care Act (ACA). First, the letter calls for a
- [Aimed Alliance Urges MD PDAB to Conduct Patient-Centered, Evidence-Based Reviews](https://aimedalliance.org/aimed-alliance-urges-md-pdab-to-conduct-patient-centered-evidence-based-reviews/) - Prior to the Maryland Prescription Drug Affordability Board’s July meeting to conduct cost affordability reviews for Farxiga and Jardiance, Aimed Alliance submitted a letter urging the Board to ensure that its reviews are evidence-based and meaningfully incorporate patient perspectives. While opportunities for public comment have been provided, Aimed Alliance emphasized the need for the Board
- [White House AI Plan May Limit State Authority on AI](https://aimedalliance.org/trumps-ai-plan-may-limit-state-ai-regulation/) - On July 4, 2025, President Trump signed the One Big Beautiful Bill Act into law, notably without a controversial provision that would have blocked states from regulating artificial intelligence (AI). However, the Trump administration appears to be pursuing the same deregulatory goal through a different avenue. The newly released AI Action Plan, “Winning the Race:
- [New Report Highlights Gaps in Insurance and AI Consumer Protections](https://aimedalliance.org/new-report-highlights-gaps-in-insurance-and-artificial-intelligence-consumer-protections/) - Washington, D.C. — June 30, 2025 — The not-for-profit Aimed Alliance, released a comprehensive new report analyzing how state policies govern step therapy, internal and external appeal oversight, and the use of artificial intelligence (AI) in health care coverage decisions. Health plans rely on a variety of benefit utilization policies, such as step therapy, to
- [Aimed Alliance Urges CMS to Prioritize Transparency in IRA Negotiations](https://aimedalliance.org/aimed-alliance-urges-cms-to-prioritize-patient-access-and-transparency-in-drug-price-negotiations/) - On June 26, 2025, Aimed Alliance submitted a comment to the Centers for Medicare & Medicaid Services (CMS) on its draft guidance for the Medicare Drug Price Negotiation Program, 2026-2028. Aimed Alliance's comment urged the agency to strengthen its approach to patient engagement by implementing a clear and continuous consumer engagement process, ensuring CMS is
- [WATCH NOW: Judicial Advocacy 101 - Tactics, Trends, and Tools by Aimed Alliance](https://aimedalliance.org/watch-now-judicial-advocacy-101-tactics-trends-and-tools-by-aimed-alliance/) - On June 5, 2025, Aimed Alliance hosted a one-hour webinar to introduce health care access advocates to the judicial system (i.e., state and federal courts) and how it can be used as a tool to complement legislative- and executive-branch advocacy efforts. The program, presented by Ashira Vantrees, Esq., Director of Legal Strategy and Advocacy for
- [New Analysis Warns IRA Changes Could Raise Drug Costs for Most Medicare Beneficiaries ](https://aimedalliance.org/new-analysis-warns-ira-changes-could-raise-drug-costs-for-most-medicare-beneficiaries/) - The Inflation Reduction Act (IRA) aimed to lower prescription drug costs by capping annual out-of-pocket spending for Medicare beneficiaries at $2,000 and eliminating the “coverage gap” for those with moderate drug expenses. However, a new white paper from the USC Schaeffer Center for Health Policy & Economics suggests that, for many beneficiaries, it may lead
- [Governor Lombardo Vetoes Bill to Impose MFP Price Caps](https://aimedalliance.org/governor-lombardo-vetoes-bill-to-impose-mfp-price-caps/) - On June 12, Nevada Governor Joe Lombardo vetoed Assembly Bill 259, legislation that would have imposed Medicare’s maximum fair price (MFP) reimbursement caps on certain prescription drugs in the state. While AB 259 aimed to control drug costs, its approach may have unintended consequences. These reimbursement caps, similar to upper payment limits (UPLs), lack any
- [Trump Administration Suspends Mental Health Parity Enforcement Amid Legal Challenge](https://aimedalliance.org/trump-administration-suspends-mental-health-parity-enforcement-amid-legal-challenge/) - The Trump administration has paused enforcement of the 2008 Mental Health Parity and Addiction Equity Act, which requires insurers to provide equal coverage for mental health/substance use disorders and medical/surgical care, and is weighing whether to repeal the rule entirely, according to a U.S. Department of Justice (DOJ) court filing. The decision follows a lawsuit
- [Columbus et al. v. Trump](https://aimedalliance.org/columbus-et-al-v-trump/) - Brief Summary: Several cities across the United States filed a class action lawsuit against President Trump, the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS), alleging that the administration is intentionally circumventing Congress and sabotaging the Patient Protection and Affordable Care Act (ACA) through executive actions.
- [Medicaid Work Requirement Cases](https://aimedalliance.org/medicaid-work-requirements/) - Brief Summary: Individuals are challenging the implementation of state policies that condition Medicaid coverage on the ability of enrollees to satisfy work requirements. The policies typically require enrollees to attest to a certain number of hours spent on activities like working or job training each month. Georgia v. Brooks-LaSure (Georgia) Overview: On December 23, 2019, the
- [Section 1557 Litigation](https://aimedalliance.org/section-1557-litigation/) - Brief Summary: Three cases – State of New York v. U.S. Department of Health and Human Services, Asapansa-Johnson Walker v. Azar, and Whitman-Walker Clinic, Inc. v. U.S. Department of Health and Human Services – challenge the U.S. Department of Health and Human Services’ regulation implementing nondiscrimination protections in healthcare under Section 1557 of the Patient
- [340B Litigation](https://aimedalliance.org/340b-litigation/) - Eli Lily & Co. v. U.S. Dept. Health & Human Services and AstraZeneca v. U.S. Dept. Health & Human Service Brief Summary: This case challenges the Department of Health and Human Services announcement that drug manufacturers had to supply 340B priced drugs to all 340B covered entities. Overview: On December 30, 2020, Health Resources and Service Administration (“HRSA”)
- [Copay Accumulators and CMS Best Price Rule](https://aimedalliance.org/copay-accumulators-and-cms-best-price-rule/) - Pharmaceutical Research and Manufacturers of America v. Becerra Brief Summary: This lawsuit challenges the Centers for Medicare and Medicaid Services’ (CMS) updated Best Price rule, which requires copay assistance to be included in a drug manufacturers Best Price calculation when a health plan utilizes a copay accumulator program. Overview: The Medicaid Rebate Statute requires drug manufacturers
- [Non-Essential Health Benefits and Copay Maximizers](https://aimedalliance.org/non-essential-health-benefits-and-copay-maximizers/) - Johnson & Johnson Health Care Sys. v. Save On SP, LLC Brief Summary: This lawsuit challenges how a third-party company called SaveonSP is partnering with health plans to run copay maximizer programs, and how this partnership interferes with Johnson & Johnson’s contractual agreement with patients who use their copay assistance program. Overview: When patients cannot
- [Employers and Mental Health Coverage](https://aimedalliance.org/employers-and-mental-health-coverage/) - The ERISA Industry Committee v. United States Department of Health and Human Services et al. Brief Summary: On January 17, 2025, the ERISA Industry Committee (ERIC) filed a lawsuit against the U.S. Departments of Health and Human Services (HHS), Labor (DOL), and the Treasury, seeking to invalidate the the Final Parity Rule implementing the Mental
- [FDA Outlines AI-Driven Reforms to Accelerate Drug Development](https://aimedalliance.org/fda-outlines-ai-driven-reforms-to-accelerate-drug-development/) - In a recent JAMA article, the FDA outlined its priorities to address delays in the drug approval process, including the use of generative AI to improve efficiency. On May 8, 2025, the agency launched its first AI-assisted scientific review pilot, using advanced generative AI to conduct initial reviews of application materials, which can exceed 500,000
- [Judicial Advocacy 101: Tactics, Trends, and Tools](https://aimedalliance.org/udicial-advocacy-101-tactics-trends-and-tools/) - Join Aimed Alliance for a Judicial Advocacy Webinar on June 5, 2025 at 1:00 PM ET This one-hour webinar will introduce advocates for health care access to the judicial system (i.e. state and federal courts) and how it can be used as a tool to complement their legislative- and executive-branch advocacy efforts. The intended audience
- [Alternative Funding Programs Litigation](https://aimedalliance.org/alternative-funding-programs-litigation/) - AbbVie v. Payer Matrix, LLC Brief summary: AbbVie, a pharmaceutical company, filed a lawsuit against Payer Matrix, an alternative funding program, alleging that the company engaged in a “fraudulent scheme” that exploits AbbVie’s charitable assistance program. Background: Alternative funding programs partner with health plans to manage the plan’s specialty medications benefits. Under these programs, plan
- [Medicare Drug Price Negotiation Litigation](https://aimedalliance.org/medicare-drug-price-negotiation-litigation/) - Nat’l Infusion Ctr. Ass’n et al. v. Becerra Brief summary: The National Infusion Center Association (NICA), Global Colon Cancer Association (GCCA), and Pharmaceutical Research and Manufacturers of America (PhRMA), filed a lawsuit against the Department of Health and Human Services alleging that the “Drug Price Negotiation Program” is unconstitutional. Background: In 2022, the United States
- [State-Based PBM Reform](https://aimedalliance.org/state-based-pbm-reform/) - Mulready v. Pharmaceutical Care Management Association Brief Summary: Pharmaceutical Care Management Association (PCMA), a trade association representing pharmacy benefit managers (PBMs), sued the Oklahoma Insurance Commissioner in an effort to invalidate an Oklahoma law aimed at improving patient access to pharmacy providers, partly by regulating PBMs. Overview: In 2019, Oklahoma passed the Oklahoma Patient's Right
- [Aimed Alliance Opposes Nevada's MFP Bill](https://aimedalliance.org/aimed-alliance-opposes-nevada-bill-to-cap-drug-prices-at-medicares-maximum-fair-price/) - Aimed Alliance sent a letter to Governor Lombardo opposing Nevada Assembly Bill 259, which would cap health plan reimbursement for select prescription drugs at the Maximum Fair Price (MFP) established by Medicare through the Inflation Reduction Act (IRA) negotiations. The bill’s approach effectively mirrors the impact of upper payment limits (UPLs) by imposing price controls
- [Aimed Alliance Urges for Clarity in Summary of Benefits](https://aimedalliance.org/aimed-alliance-urges-for-clarity-in-summary-of-benefits/) - On May 30, Aimed Alliance submitted a comment to the Department of Labor regarding the Summary of Benefits disclosures health plans are required to provide plan beneficiaries. The comment highlighted the value of uniform language to allow consumers to easily compare plan options, and the importance of clear disclosures relating to the use of copay
- [Aimed Alliance Urges New York to Improve Access to Medications for SMIs](https://aimedalliance.org/aimed-alliance-urges-new-york-to-improve-access-to-medications-for-smis/) - Aimed Alliance sent a letter supporting New York Senate Bill 4867, which aims to prohibit the use of prior authorization and step therapy protocols for diagnosing and treating serious mental illnesses (SMIs). Conditions like schizophrenia, bipolar disorder, major depressive disorder, and PTSD require prompt, individualized care, but these administrative barriers often delay or interrupt access
- [Aimed Alliance Urges Stronger Oversight of ACA Appeals Procedures](https://aimedalliance.org/aimed-alliance-urges-stronger-oversight-of-aca-appeals-procedures/) - In response to a request for information regarding the Affordable Care Act’s (ACA) internal and external appeals procedures, Aimed Alliance submitted comments to the U.S. Department of Labor urging continued oversight of these processes. Aimed Alliance’s comment highlighted concerns about expedited decisions by Independent Review Organizations (IROs) that inadequately assess complex medical claims, denial letters
- [Aimed Alliance Urges New Jersey Legislature to Improve Access to Medications for SMIs](https://aimedalliance.org/aimed-alliance-urges-new-jersey-legislature-to-improve-access-to-medications-for-smis/) - Aimed Alliance sent a letter in support of New Jersey Senate Bill 1192, which aims to prohibits the use of utilization management tools, such as prior authorization and step therapy, for prescription drugs used to treat serious mental illnesses (SMIs). These conditions, including schizophrenia, bipolar disorder, major depressive disorder, and PTSD, require timely, individualized treatment
- [Aimed Alliance Supports Minnesota Bill to Protect Access to Mental Health Medications](https://aimedalliance.org/aimed-alliance-supports-minnesota-bill-to-protect-access-to-mental-health-medications/) - Aimed Alliance sent a letter to the Minnesota Health and Human Services Committee in support of Senate Bill 2392, which seeks to prohibit the use of utilization management tools, such as prior authorization and step therapy, for certain central nervous system medications used to treat serious mental illnesses (SMIs) including schizophrenia, bipolar disorder, and major
- [IRA Price Controls May Be Linked to Higher Out-of-Pocket Drug Costs ](https://aimedalliance.org/ira-price-controls-may-be-linked-to-higher-out-of-pocket-drug-costs/) - A new analysis from the Pioneer Institute shows that federal price controls under the Inflation Reduction Act (IRA) may be have unintended consequences on consumers' prescription drug costs. The IRA Medicare Drug Access Tracker, which monitors the law’s impact, recently found that these controls are actually increasing out-of-pocket costs for many seniors. Among nine widely used
- [Aimed Alliance Urges Oregon PDAB to Ensure Robust Data Collection Process](https://aimedalliance.org/aimed-alliance-urges-oregon-pdab-to-ensure-robust-data-collection-process/) - The Oregon Prescription Drug Affordability Board is currently reviewing the affordability of 27 selected medications and has requested feedback from individuals and organizations to inform its assessments. In response, Aimed Alliance submitted a comment urging the Board to adopt a deliberate, evidence-based approach to its evaluations and decision-making. The letter emphasized the importance of meaningfully
- [Cassidy Unveils 340B Investigation Findings and Reform Suggestion](https://aimedalliance.org/cassidy-unveils-340b-investigation-findings-and-reform-suggestion/) - Senate Health Committee Chair Bill Cassidy (R-LA) released findings from a multi-year investigation into the 340B drug discount program focusing on how safety net providers and contract pharmacies use program savings. The report found that hospitals generate hundreds of millions of dollars in 340B revenue without directly passing savings on to patients. While some hospitals
- [Aimed Alliance & HR.com Launch Menopause in the Workplace Resources](https://aimedalliance.org/aimed-alliance-hr-com-launch-menopause-resources/) - Aimed Alliance and HR.com have launched a new webpage highlighting our 2024 survey findings; infographic, and webinar for employers and human resource professionals. This new all-in-one page shares key findings from Aimed Alliance’s recent survey, which uncovered significant gaps between awareness of menopause-related challenges and the level of support provided to affected employees. It also
- [Health Experts Launch Vaccine Integrity Project to Protect Science-Based Immunization Guidance  ](https://aimedalliance.org/health-experts-launch-vaccine-integrity-project-to-protect-science-based-immunization-guidance/) - A group of U.S. health experts have launched the Vaccine Integrity Project, an additional source of science-based vaccine recommendations, functioning independently of the Advisory Committee on Immunization Practices (ACIP). ACIP is a panel of medical and public health experts housed within the Center for Disease Control and Prevention (CDC) that guides U.S. vaccine policy by
- [New Resource Tariffs 101: How Tariffs Could Impact Patients](https://aimedalliance.org/tariffs-101-what-tariffs-may-mean-for-patients/) - On April 22, 2025, Aimed Alliance released a new resource titled "Tariffs 101: How Tariffs Could Impact Patients." Since the start of 2025, the term “tariffs” has become increasingly common in the media and among legislators, regulators, and elected officials. On April 2, President Donald Trump announced a sweeping set of tariffs affecting nearly every country,
- [Oregon Senator Delays Bill Granting PDAB UPL Authority Amid Uncertainty ](https://aimedalliance.org/oregon-senator-delays-bill-granting-pdab-upl-authority-amid-uncertainty/) - Oregon Senator Deb Patterson, Chair of the Senate Health Care Committee, has decided not to introduce a bill this session that would allow Oregon’s Prescription Drug Affordability Board (PDAB) to set upper payment limits (UPLs) for certain prescription drugs. Senator Patterson now plans to postpone any price-cap legislation until at least 2027. When announcing her
- [Youngkin Vetoes PDAB Bill in Virginia for Second Year](https://aimedalliance.org/youngkin-vetoes-pdab-bill-in-virginia-for-second-year/) - For the second consecutive year, Governor Glenn Youngkin has vetoed legislation aimed at establishing a Prescription Drug Affordability Board (PDAB). Governor Youngkin reasoned that the bill was vetoed as it could restrict patient access to critical medications by prioritizing cost control over medical necessity, particularly for individuals with rare or life-threatening conditions. The veto memo
- [Aimed Alliance Released Updated Gold Card Legislation Resource](https://aimedalliance.org/aimed-alliance-released-updated-gold-card-legislation-resource/) - Gold card laws exempt healthcare providers from prior authorization if they have a high approval rate, reducing delays in patient care and administrative burdens. These laws aim to streamline access to treatment by allowing providers to bypass burdensome authorization requirements. In 2022 and 2023, Aimed Alliance released a Gold Card tool summarizing gold card legislation
- [Congress Reintroduces The HELP Copays Act](https://aimedalliance.org/help-copays-act-reintroduced-to-ensure-fair-cost-sharing-for-patients/) - Members of the 119th Congress have reintroduced The Help Ensure Lower Patient Copays Act (HELP Copays Act), S.864,, which aims to protect patients by ensuring that all payments, whether from their own pockets or through copay assistance, count towards cost-sharing obligations. . Many patients rely on financial assistance to help meet copay obligations, but copay
- [Aimed Alliance Supports Biomarker Bill in Tennessee](https://aimedalliance.org/aimed-alliance-supports-expanding-access-to-biomarker-testing-in-tennessee/) - Aimed Alliance recently submitted a letter to the Tennessee legislature in support of House Bill 484, which would require Tennessee health plans to cover biomarker testing when supported by medical and scientific evidence. This legislation represents a crucial step in advancing personalized medicine and ensuring patients have access to the most effective diagnostic and treatment
- [Aimed Alliance Supports Oregon Bill to Expand Access to Biomarker Testing](https://aimedalliance.org/aimed-alliance-supports-oregon-bill-to-expand-access-to-biomarker-testing/) - Aimed Alliance has submitted a letter to the Oregon legislature in support of House Bill 3241, which would require health plans to cover biomarker testing when supported by medical and scientific evidence. By ensuring coverage when supported by medical and scientific evidence, this legislation will expand access to biomarker testing, allowing patients to receive targeted
- [Aimed Alliance Encourages Michigan to Consider PDAB Alternatives](https://aimedalliance.org/aimed-alliance-encourages-michigan-to-consider-pdab-alternatives/) - On March 17, Aimed Alliance sent a letter to the Michigan legislature urging the Senate Committee on Finance, Insurance, and Consumer Protection to carefully assess the potential impacts of S.B. 3, which would establish a prescription drug affordability board. The letter urged the committee to consider alternative legislation that could more effectively reduce prescription drug
- [Aimed Alliance Urges Illinois Lawmakers to Strengthen Patient Protections in Prescription Drug Pricing Board](https://aimedalliance.org/aimed-alliance-urges-illinois-lawmakers-to-strengthen-patient-protections-in-prescription-drug-pricing-board/) - On March 17, Aimed Alliance sent a letter to Illinois Legislature urging the General Assembly to amend S.B. 66, which seeks to establish the Health Care Availability and Access Board—effectively serving as a prescription drug affordability board. The letter emphasizes the need to prioritize patients by incorporating their perspectives and lived experiences, mandating an ongoing
- [Aimed Alliance Calls for PBM Reform in West Virginia](https://aimedalliance.org/aimed-alliance-calls-for-pbm-reform-in-west-virginia/) - On March 19, Aimed Alliance sent a letter to West Virginia legislature urging the House Committee on Health and Human Resources to assess the potential consequences of House Bill 2831, which proposes the establishment of a prescription drug affordability board in West Virginia. The letter urged the Committee to consider alternatives such as pharmacy benefit
- [Report Reveals Methodological Flaws in MedPAC’s Medicare Advantage Analysis](https://aimedalliance.org/report-reveals-methodological-flaws-in-medpacs-medicare-advantage-analysis/) - A recent report commissioned by America’s Health Insurance Plans (AHIP) challenges the findings of the Medicare Payment Advisory Commission (MedPAC) in its March 2024 report to Congress. In its' March 2024 report MedPAC concluded that Medicare Advantage (MA) plans were paid 22% more in 2021 than what Medicare would have spent had those beneficiaries were
- [Aimed Alliance Asks Kansas to Consider Alternative to PDAB Legislation](https://aimedalliance.org/aimed-alliance-asks-kansas-to-consider-alternative-to-pdab-legislation/) - Aimed Alliance submitted a letter to the Kansas Legislature, urging the Committee on Financial Institutions and Insurance to evaluate the potential impact of S.B. 212, which seeks to create a prescription drug affordability board. The letter recommends exploring alternative measures that more effectively lower prescription drug costs for consumers, such as implementing a copay accumulator
- [Aimed Alliance Supports Access to Biomarker Testing in Hawaii](https://aimedalliance.org/aimed-alliance-supports-access-to-biomarker-testing-in-hawaii/) - Aimed Alliance submitted a letter in support of Hawaii House Bill 553, which would require health plans to cover biomarker testing for the diagnosis, treatment, management, and ongoing monitoring of diseases. Biomarker testing is a critical tool that enables healthcare providers to collect individualized patient data, facilitating the tailored prevention, diagnosis, and treatment of diseases.
- [New Article “Menopause in the Workplace: Supporting Women through Career Transitions”](https://aimedalliance.org/new-article-menopause-in-the-workplace-supporting-women-through-career-transitions/) - The February 2025 issue of HR.com’s Employee Benefits & Wellness Excellence magazine featured an article by Aimed Alliance Staff Attorney, Olivia Backhaus, titled “Menopause in the Workplace: Supporting Women through Career Transitions." The article addresses the ongoing stigma surrounding menopause and its impact on women in the workplace. It also highlights findings from Aimed Alliance’s
- [Aimed Alliance Releases 2024 Annual Impact Report](https://aimedalliance.org/aimed-alliance-releases-2024-annual-impact-report-2/) - In 2024, Aimed Alliance engaged in a wide variety of activities to protect and enhance the rights of health care consumers and providers, and ensure that rapidly evolving conversations around health care affordability center the lived experiences of patients and providers. We are pleased to share our 2024 Annual Impact Report, which highlights the progress
- [Aimed Alliance Supports Transparency and Investment in Primary Care in Washington](https://aimedalliance.org/aimed-alliance-supports-transparency-and-investment-in-primary-care-in-washington/) - Aimed Alliance submitted a letter in support for Washington Senate Bill 5084, which mandates annual reporting of primary care expenditures by health carriers to enhance transparency in healthcare spending. Primary care services, such as preventive care, medical exams, and chronic disease management, are essential to an efficient and effective healthcare system. By increasing transparency in
- [Aimed Alliance Supports Creation of Rare Disease Council in Washington](https://aimedalliance.org/aimed-alliance-supports-creation-of-rare-disease-council-in-washington/) - Aimed Alliance provided a letter of support for the passage of Washington Senate Bill 5064, which would establish an advisory council on rare diseases. The advocacy council would advise the Washington Secretary of Health on research, diagnosis, treatment, and education related to rare diseases. Establishing a rare disease advisory council would also help ensure the
- [Aimed Alliance Comments on Maryland PDAB Draft Rules](https://aimedalliance.org/aimed-alliance-comments-on-maryland-pdab-draft-rules/) - Aimed Alliance provided feedback on Maryland’s Prescription Drug Affordability Board’s draft regulations, COMAR 14.01.0 and COMAR 14.01.05, which amend and establish rules on the Board’s procedures, policy review, and upper payment limits (UPL). Aimed Alliance’s comment focused on how the proposed UPL methodology only considers total out-of-pocket costs for state, county, and municipal health plans,
- [Aimed Alliance Supports Increased Access to Biomarker Testing in Connecticut](https://aimedalliance.org/aimed-alliance-supports-increased-access-to-biomarker-testing-in-connecticut/) - Aimed Alliance submitted a letter of support for Connecticut House Bill 06771, which seeks to ensure health plans cover biomarker testing for disease diagnosis, treatment, and management. Aimed Alliance supports expanding access to biomarker testing as this can advance medical diagnostics and personalized treatment, ensuring patients receive the most effective care and providers have the
- [Survey Reveals Major Gaps in Workplace Support for Women's Midlife Health Needs](https://aimedalliance.org/survey-reveals-major-gaps-in-workplace-support-for-womens-midlife-health-needs/) - WASHINGTON, DC / ACCESS Newswire / February 28, 2025 / New survey findings released today reveal significant gaps between awareness of menopause-related workplace challenges and organizational support for affected employees. The report, "Understanding the Health Issues of Women in Midlife," examines how employers understand and address the difficulties faced by employees in midlife, including women experiencing perimenopause and
- [Aimed Alliance Urges Virginia to Reconsider PDAB Bill](https://aimedalliance.org/aimed-alliance-urges-virginia-to-reconsider-pdab-bill/) - On January 24, 2025, Aimed Alliance submitted a comment to the Virginia House Appropriations – Health and Human Resources Subcommittee, urging them to reconsider VA HB 1724 and instead pursue legislation that directly reduces health care costs for consumers. Aimed Alliance's comment highlighted concerns with prescription drug affordability boards (PDABs), noting that upper payment limits
- [Aimed Alliance Releases New Resource On New York's 2024 Step Therapy Law](https://aimedalliance.org/aimed-alliance-releases-new-resource-on-new-yorks-2024-step-therapy-law/) - At the end of 2024, Governor Kathy Hochul signed Senate Bill 1267A/Assembly Bill A901A which enacted new protections for consumers against step-therapy policies. This new law will take effect on January 1, 2026. The law prohibits the following step therapy protocols: Requiring the patient to try and fail on: Medications not FDA-approved or recommended in evidence-based
- [Survey Finds 30% of Independent Pharmacies Will Not Stock Certain IRA-Negotiated Drugs](https://aimedalliance.org/survey-finds-30-of-independent-pharmacies-will-not-stock-certain-ira-negotiated-drugs/) - New data released by the National Community Pharmacists Association (NCPA) finds that roughly 30 percent of independent pharmacies have chosen not to stock certain drugs selected for Medicare’s drug price negotiation. NCPA surveyed 8,000 pharmacy owners and managers in January 2025, finding that about 93 percent of independent pharmacists are either already not or are
- [Aimed Alliance Pushes for Transparency in AI Prior Authorization Decisions](https://aimedalliance.org/aimed-alliance-pushes-for-transparency-in-ai-prior-authorization-decisions/) - Aimed Alliance submitted written testimony regarding Washington’s Senate Bill 5395 and House Bill 1566, which aim to improve transparency and accountability in the prior authorization process, particularly when artificial intelligence (AI) is involved in coverage determinations. The letter expressed Aimed Alliance's support for the bills’ provisions that prevent AI from being the sole basis for
- [Aimed Alliance Advocates for Clarifications to WA Obesity Treatment Access Legislation](https://aimedalliance.org/aimed-alliance-advocates-for-clarifications-to-wa-obesity-treatment-access-legislation/) - In February 2025, Aimed Alliance submitted a comment on Washington Senate Bill 5353, which would require health carriers to provide coverage for the diagnosis and treatment of obesity. While Aimed Alliance supports the bill as an important step in ensuring comprehensive care for individuals with obesity, the comment urged the Committee to strengthen protections against
- [Aimed Alliance Urges Patient-Focused Amendments to MD PDAB Bill](https://aimedalliance.org/aimed-alliance-urges-patient-focused-amendments-to-md-pdab-bill/) - Aimed Alliance provided comments on Maryland’s SB0357/HB0424, legislation that would enable the Maryland Prescription Drug Affordability Board (PDAB) to establish a process for setting upper payment limits (UPLs) for certain eligible prescription drugs. The legislation would also require the Board to determine whether setting UPLs for all purchases and payor reimbursements is in the state’s
- [DOL Confirms FMLA Can Be Used For Clinical Trial Participation](https://aimedalliance.org/dol-confirms-fmla-can-be-used-for-clinical-trial-participation/) - In November 2024, the Department of Labor (DOL) issued an advisory opinion confirming the Family Medical Leave Act (FMLA) could be used to allow individuals to participate in clinical trials. Previously, consumers were unclear whether clinical trial participation qualified for FMLA leave as some individuals would receive a placebo rather than medical treatment during clinical
- [Aimed Alliance Comments on 2026 Proposed Changes to Medicare & Medicaid](https://aimedalliance.org/aimed-alliance-submits-recommendations-for-medicare-medicaid-rule-changes/) - On January 27, 2025, Aimed Alliance submitted a comment on the Centers for Medicare & Medicaid Services (CMS) proposed rule changes for the 2026 Medicare and Medicaid plan year. Aimed Alliance urged CMS to monitor access to Inflation Reduction Act (IRA)-negotiated prescription drugs and increase transparency in AI-driven coverage determinations. The IRA of 2022 enables
- [Aimed Alliance Urges CMS to Finalize Coverage of Obesity Treatments Proposed Rule](https://aimedalliance.org/aimed-alliance-urges-cms-to-finalize-coverage-of-obesity-treatments-proposed-rule/) - On January 27, 2025, Aimed Alliance commented on the Centers for Medicare & Medicaid Services (CMS) proposed rule to expand Medicare and Medicaid coverage for obesity treatments. In its comment, Aimed Alliance urged CMS to swiftly finalize the rule, and ensure that health plans implement utilization management policies based on clinical evidence. Specifically, Aimed Alliance
- [Aimed Alliance Supports Missouri Copay Accumulator Ban](https://aimedalliance.org/aimed-alliance-provides-support-for-missouri-copay-accumulator-bill/) - On January 22, 2025, Aimed Alliance submitted a letter to the Families, Seniors, and Health Committee in support of Senate Bill 45, which seeks to prohibit copay accumulator policies in Missouri. The letter highlights the significant concerns associated with these programs, emphasizing that they can lead to disease progression, relapse, and other adverse health events,
- [Report Finds Racial Disparities in Medicare Advantage Physician Networks](https://aimedalliance.org/report-finds-racial-disparities-in-medicare-advantage-physician-networks/) - A report by the Brown University Center for Advancing Health Policy through Research (CAHPR) highlights that Medicare Advantage (MA) plans, which enroll a high proportion of Black and Hispanic individuals, are failing to provide adequate access to racially or ethnically similar physicians. Analyzing 2019 data, the report found significant disparities in physician inclusion rates, finding
- [FTC Second Interim Staff Report Finds PBMs Significantly Mark Up Drugs](https://aimedalliance.org/ftc-second-interim-staff-report-finds-pbms-significantly-mark-up-drugs/) - On January 14, 2024, the Federal Trade Commission (FTC) released its second report investigating the pharmacy benefit manager (PBM) industry. The report, which focuses on PBMs’ influence over specialty generic drugs, revealed that the top three PBMs—Express Scripts, CVS Caremark, and Optum Rx—generated over $7.3 billion in dispensing revenue from specialty generic drugs, far exceeding
- [AI Task Force Publishes Report on AI Recommendations](https://aimedalliance.org/ai-task-force-publishes-report-on-ai-recommendations/) - In December 2024, the Bipartisan Artificial Intelligence (AI) Task Force released the “Bipartisan House Task Force Report on Artificial Intelligence.” Comprising 24 members evenly split between Republicans and Democrats from 20 committees. The Task Force aims to create a comprehensive vision for AI adoption, innovation, and governance in the U.S. The 2024 report includes 66
- [CBO Outlines Options for Reducing Federal Deficits](https://aimedalliance.org/cbo-outlines-options-for-reducing-federal-deficits/) - The 119th, Congress faces critical policy decisions to address rising federal deficits, which are projected by the Congressional Budget Office (CBO) to average $1.9 trillion annually from 2025 to 2034. In December 2024, CBO issued a report of policy options for reducing deficits over the next decade. In health care, key recommendations include: Medicaid: Cap
- [FDA Issues Draft Guidance on AI in Medical Devices and Drug Development ](https://aimedalliance.org/fda-issues-draft-guidance-on-ai-in-medical-devices-and-drug-development/) - On January 6, 2025, the U.S. Food & Drug Administration released two draft guidance documents on artificial intelligence (AI). The first, "AI-Enabled Device Software Functions: Lifecycle Management and Marketing Submission Recommendations," offers guidance to support the safety and effectiveness of AI-enabled devices throughout their lifecycle, including design, development, maintenance, and documentation. It also outlines when
- [Governor Hochul Signs Step Therapy Reform Measures Into Law](https://aimedalliance.org/hochul-signs-step-therapy-reform-measures-into-law/) - New law limits methods health insurers and PBMs can use to delay and discourage access to medically necessary treatments. ALBANY, NY / ACCESSWIRE / December 23, 2024 / New York Gov. Kathy Hochul signed legislation on December 21 that puts new controls on the state's health insurers and pharmacy benefit managers (PBMs). The new law limits
- [Aimed Alliance Submits Recommendations to Improve Vaccine Strategy](https://aimedalliance.org/aimed-alliance-submits-recommendations-to-improve-vaccine-strategy/) - On October 7, 2024, the U.S. Department of Health and Human Services (HHS) issued a Request for Information (RFI) to inform the development of the 2026-2030 National HIV/AIDS Strategy and the National Strategic Plans for Sexually Transmitted Infections, Vaccines, and Viral Hepatitis. In response, Aimed Alliance submitted feedback outlining key recommendations to strengthen public health
- [New Webinar: Supporting Women in Midlife: Survey Insights on Workplace Practices and Employee Benefits](https://aimedalliance.org/new-webinar-supporting-women-in-midlife-survey-insights-on-workplace-practices-and-employee-benefits/) - On December 4, 2024, Aimed Alliance hosted a webinar on HR.com titled "Supporting Women in Midlife: Survey Insights on Workplace Practices and Employee Benefits." View the webinar below.
- [Watch Now: HR.com Webinar Copay Compliance Understanding Cost- Sharing and Fiduciary Obligations for Employers](https://aimedalliance.org/dea-issues-third-extension-of-temporary-telemedicine-flexibilities-2/) - On November 14, 2024, Aimed Alliance and the Alliance for Patient Access (AfPA) hosted a webinar on HR.com titled "Copay Compliance Understanding Cost-Sharing and Fiduciary Obligations for Employers." View the webinar below.
- [Aimed Alliance Releases 2023 Annual Impact Report](https://aimedalliance.org/aimed-alliance-releases-2023-annual-impact-report/) - In 2023, Aimed Alliance engaged in a wide variety of activities to protect and enhance the rights of health care consumers and providers, and ensure that rapidly evolving conversations around health care affordability center the lived experiences of patients and providers. We are pleased to share our 2023 Annual Impact Report, which highlights the progress
- [DEA Issues Third Extension of Temporary Telemedicine Flexibilities](https://aimedalliance.org/dea-issues-third-extension-of-temporary-telemedicine-flexibilities/) - The U.S. Drug Enforcement Administration (DEA) has extended the temporary telemedicine flexibilities allowing providers to prescribe controlled substances without an initial in-person visit through December 31, 2025, previously set to expire at the end of 2024. These flexibilities were initially introduced during the COVID-19 public health emergency to ensure continued access to critical healthcare services.
- [Health AI Coalition Releases Framework to Evaluate Safety and Effectiveness of AI Tools](https://aimedalliance.org/health-ai-coalition-releases-framework-to-evaluate-safety-and-effectiveness-of-ai-tools/) - The Coalition for Health AI (CHAI), a group of stakeholders that collaborate to drive the development, evaluation, and appropriate use of AI in healthcare, has introduced draft frameworks for AI assurance labs and model cards aimed at enhancing transparency and trust in healthcare AI tools. The assurance labs would evaluate AI tools for safety and
- [Aimed Alliance Comments Urging Revisions to Maryland's New PDAB Rules](https://aimedalliance.org/aimed-alliance-comments-urging-revisions-to-marylands-new-pdab-rules/) - On November 8, 2024, Aimed Alliance submitted feedback to the Maryland Prescription Drug Affordability Board regarding its updated rules for policy review, final actions, upper payment limits (UPLs), and hearing procedures. In it's comment, Aimed Alliance urged the Board to adopt a patient-centered approach in the policy review process, consider a ban on copay accumulators
- [Independent Pharmacies May Drop Medicare Part D Negotiated Drugs](https://aimedalliance.org/independent-pharmacies-may-drop-medicare-part-d-negotiated-drugs/) - A recent survey by the National Community Pharmacists Association (NCPA) indicates that over 90 percent of independent pharmacies may choose not to stock Medicare Part D drugs that were selected for price negotiation. This reluctance is driven by concerns that the Centers for Medicare & Medicaid Services’ (CMS) drug price negotiation program lacks protocols to
- [Medicare Coverage of Anti-Obesity Medications Could Result in Substantial Savings](https://aimedalliance.org/medicare-coverage-of-anti-obesity-medications-could-result-in-substantial-savings/) - Currently, Medicare coverage for anti-obesity medications is limited to indications for diabetes and cardiovascular disease. Policymakers, however, have proposed expanding this to authorize broader Medicare coverage for these medications. On October 8, the Congressional Budget Office (CBO) released a report estimating the budgetary effects of an illustrative policy that would allow Medicare coverage for anti-obesity
- [National AI Advisory Committee Releases AI Priorities for the Next Administration](https://aimedalliance.org/national-ai-advisory-committee-releases-ai-priorities-for-the-next-administration/) - On October 10, 2024, the National AI Advisory Committee released its draft transition plan for the incoming administration. The report aims to enhance opportunities and mitigate the risks associated with AI use both within the government and the broader public. It outlines strategies involving funding, executive actions, regulations, enforcement, and other tools available to
- [Survey Finds Patients Experience Delays, Stress, and Health Impacts from Alternative Funding Programs](https://aimedalliance.org/survey-finds-patients-experience-delays-stress-and-health-impacts-from-alternative-funding-programs/) - A recent survey of 227 patients examining patients’ experiences with alternative funding programs (AFP) found that most patients subject to alternative funding programs experience significant delays, stress, and discomfort with the AFP process, which can negatively impact their health and job satisfaction. In reviewing patients’ experiences with AFPs, the survey found that 88 percent of
- [UPCOMING WEBINAR: Supporting Women in Midlife: Survey Insights on Workplace Practices and Employee Benefits](https://aimedalliance.org/upcoming-webinar-supporting-women-in-midlife-survey-insights-on-workplace-practices-and-employee-benefits/) - Join Aimed Alliance and HR.com for an upcoming webinar on December 4, 2024 at 3PM ET. Menopause and perimenopause are significant life stages that can have profound effects on workplace productivity and women’s career growth. Despite the growing recognition of the need for inclusive workplace policies, the specific career-related challenges faced by women in midlife
- [Aimed Alliance Calls for Changes to Maryland’s PDAB Action Plan](https://aimedalliance.org/aimed-alliance-calls-for-changes-to-marylands-prescription-drug-affordability-action-plan/) - On October 18, 2024, Aimed Alliance sent a letter to the Maryland Legislative Policy Committee, urging it to make major improvements to the Maryland’s Prescription Drug Affordability Board’s Action Plan. Aimed Alliance specifically requested that the Board revise its plan to incorporate patient perspectives by ensuring that feedback from patients, caregivers, and providers is considered
- [Aimed Alliance Submits Feedback on Proposed Changes to Colorado PDAB Rules](https://aimedalliance.org/aimed-alliance-submits-feedback-on-proposed-changes-to-colorado-pdab-rules/) - On October 16, 2024, Aimed Alliance submitted a comment to Colorado’s PDAB regarding proposed changes to its Drug Affordability Review Policies and Rules. The comment highlighted concerns about amendments to the orphan drug designation and patient and caregiver input processes. In addition, the letter commends the Board for recognizing how drug prices may affect consumers’
- [UPCOMING WEBINAR: Copay Compliance: Understanding Cost-Sharing and Fiduciary Obligations for Employers](https://aimedalliance.org/upcoming-webinar-copay-compliance-understanding-cost-sharing-and-fiduciary-obligations-for-employers/) - November 14, 2024 at 11am ET Copay Compliance: Understanding Cost-Sharing and Fiduciary Obligations for Employers Join the Alliance for Patient Access, HR.com and Aimed Alliance for a free webinar about copay diversion programs, including alternative funding programs. The discussion will include: How cost diversion programs like alternative funding programs can impact the health of employees with chronic
- [Aimed Alliance Releases New 2024 PDAB Resources](https://aimedalliance.org/aimed-alliance-releases-new-2024-pdab-resources/) - Aimed Alliance is pleased to share three new resources on prescription drug affordability boards (PDABs). PDABs are established at the state level and aim to combat the escalating costs of prescription drugs. Due to the diverse approaches taken by different states, Aimed Alliance has developed three new resources to inform advocates and stakeholders on the
- [Aimed Alliance Releases Medicare Part D Smoothing Resource](https://aimedalliance.org/aimed-alliance-releases-medicare-part-d-smoothing-resource/) - In August 2022, President Biden signed the Inflation Reduction Act (IRA) into law. The IRA strives to enhance Medicare by expanding benefits, lowering drug costs, and improving the sustainability of the program. Effective January 1, 2025, the IRA requires several notable changes to Medicare prescription drug plans (Part D plans), including imposing a $2,000 annual
- [Governor Vetoes Virginia PDAB Bill](https://aimedalliance.org/governor-vetoes-virginia-pdab-bill/) - On April 8, 2024, Governor Youngkin of Virginia vetoed a bill aimed at establishing a Prescription Drug Affordability Board (PDAB) in the state, opting instead to advocate for increased transparency in drug pricing. The proposed legislation would have empowered the PDAB to set upper payment limits on prescription drugs. The veto reasoned that there is
- [Aimed Alliance Urges Illinois to Implement Alternative Legislative Reforms to PDABs](https://aimedalliance.org/aimed-alliance-urges-illinois-to-implement-alternative-legislative-reforms-to-pdabs/) - On September 3, 2024, Aimed Alliance sent letters to Illinois Senate Majority Leader Kimberly Lightford and House Majority Robyn Gabel, urging them to consider alternatives to creating a prescription drug affordability board (PDAB) in Illinois. The letters emphasizes the need for solutions that directly improve consumer access and affordability. The letters express concerns that PDABs
- [Illinois Passes Monumental Healthcare Protection Act Enhancing Patient Rights and Access ](https://aimedalliance.org/illinois-passes-monumental-healthcare-protection-act-enhancing-patient-rights-and-access/) - On July 10, 2024, Illinois took significant strides toward improving healthcare access and patient rights with the passage the Healthcare Protection Act. Enacted to bolster consumer protections and streamline healthcare processes, this comprehensive legislation introduces multiple reforms aimed at safeguarding patient rights and enhancing transparency in health care. Key provisions include: Step Therapy Ban: Starting
- [Aimed Alliance to Speak at the Ohio Rare Disease Summit](https://aimedalliance.org/join-aimed-alliance-at-the-ohio-rare-disease-summit/) - Aimed Alliance’s Counsel, Ashira Vantrees, will be speaking to employers at the Ohio Rare Disease Summit on "Managing Prescription Drug Costs: Navigate today’s pharmacy benefits efficiently, effectively and ethically". Ms. Vantrees will discuss Aimed Alliance and AfPA's 2023 employer survey on alternative funding programs. The presentation will take place on September 26, 2024. Register for
- [Aimed Alliance Sends Letter on Nebraska's PDAB Proposal](https://aimedalliance.org/aimed-alliance-sends-letter-on-nebraskas-pdab-proposal/) - On May 7, 2024, Aimed Alliance submitted a letter to the Nebraska Banking, Commerce, and Insurance Committee regarding L.B.33, which proposes the establishment of a Prescription Drug Affordability Board (PDAB). In our letter, we expressed concerns about the experimental nature of PDAB initiatives and underscored the importance of ensuring that cost savings directly benefit consumers.
- [ADVOCACY WIN: Nevada Insurance Commissioner to Enforce 2020 NBPP and Address Non-EHB Designation](https://aimedalliance.org/aimed-alliance-advocacy-win-nevada-insurance-commissioner-to-enforce-2020-nbpp-and-address-non-ehb-designation/) - On Friday, May, 24 2024, Aimed Alliance and The AIDS Institute met with members of the Nevada Division of Insurance, including Insurance Commissioner Scott Kipper and Chief Deputy Insurance Commissioner Todd Rich, to discuss Aimed Alliance's letter regarding the 2020 NBPP and the use of non-essential health benefit language in Nevada ACA-regulated plans, as identified in The AIDS Institute's
- [Aimed Alliance Urges Hawaii Legislature to Pass Biomarker Legislation](https://aimedalliance.org/aimed-alliance-urges-hawaii-legislature-to-pass-biomarker-legislation/) - Aimed Alliance recently urged the Hawaii legislature to swiftly pass comprehensive biomarker legislation to ensure consumers have access to these necessary and informative tests. Biomarker testing plays a pivotal role in gathering personalized information essential for the disease prevention, diagnosis, and treatment. Read our letter here.
- [Maryland's PDAB Initiates Cost Review for Six Drugs](https://aimedalliance.org/marylands-pdab-initiates-cost-review-for-six-drugs/) - On May 20, 2024, Maryland’s Prescription Drug Affordability Board (PDAB) voted to initiate cost review and affordability studies for six drugs. In conducting affordability reviews, the Board will consider various factors, including wholesale acquisition costs, price concessions and rebates from manufacturers, costs to health plans, patient access impacts, and the financial implications of therapeutic alternatives.
- [Maryland PDAB Meets to Discuss Drug Cost Review Process](https://aimedalliance.org/maryland-pdab-meets-to-discuss-drug-cost-review-process/) - On July 22, 2024, the Maryland Prescription Drug Affordability Board (PDAB) met to discuss the upcoming timeline for the next phase of its drug cost review process. The upcoming timeline includes: Drug Selection and Comment Period: The drugs selected for cost review were posted on the Board’s website in May. Written comments on the selected
- [Maryland PDAB Approves UPL Action Plan and Updated Cost Review Regulations](https://aimedalliance.org/maryland-pdab-approves-upl-action-plan-and-updated-cost-review-regulations/) - At its September 10th meeting, the Maryland Prescription Drug Affordability Board (PDAB) approved its upper payment limit (UPL) action plan and updated its cost review regulations. Before the approval, the Board reviewed key themes from public comments, including suggestions to delay the UPL process, calls for greater specificity in the criteria and procedures, and concerns
- [Governor Signs Bill to Reform Prior Authorization Practices in Vermont](https://aimedalliance.org/governor-signs-bill-to-reform-prior-authorization-practices-in-vermont/) - On May 20, 2024, Governor Phil Scott signed H.766, which aims to reform prior authorization practices and reduce administrative delays to improve patient care in Vermont. The new law eliminates prior authorization for any in-network service ordered by a primary care provider, ensuring timely access to necessary treatments. It also mandates prompt response times for
- [Aimed Alliance Releases New Resource on Vermont Step Therapy Law](https://aimedalliance.org/aimed-alliance-releases-new-resource-on-vermont-step-therapy-law-2/) - During the 2024 legislative session, Vermont passed a step-therapy law that placed guardrails on step-therapy policies to protect health care consumers. Step therapy, also known as fail-first, requires consumers to try and fail on alternative treatments before the plan will cover the originally prescribed treatment. To ensure providers are aware of their rights and benefits
- [Colorado’s PDAB Declares Third Drug Unaffordable ](https://aimedalliance.org/colorados-pdab-declares-third-drug-unaffordable/) - On June 14, the Colorado Prescription Drug Affordability Board (PDAB) voted that a prescription drug used to treat various forms of psoriasis, arthritis, spondylitis, and hidradenitis suppurativa, was unaffordable for residents of the state. This is the third drug to receive an "unaffordable" designation from the Board. Since the drug has now been deemed unaffordable,
- [Colorado PDAB Calls for Strengthening Consumer Input](https://aimedalliance.org/colorado-pdab-calls-for-strengthening-consumer-input/) - Colorado’s Prescription Drug Affordability Board (PDAB) has issued recommendations to the state legislature aimed at enhancing consumer involvement, adjusting eligibility thresholds, and incorporating additional rebate data into their prescription drug review process. In a report detailing its 2023 activities, it states, “The Board recommends the General Assembly consider revising section 10-16-1406(1), C.R.S. to allow for
- [Colorado PDAB’s September Meeting: Updates on Affordability Review and UPL Rulemaking](https://aimedalliance.org/colorado-pdabs-september-meeting-updates-on-affordability-review-and-upl-rulemaking/) - On September 6, 2024, the Colorado Prescription Drug Affordability Board (PDAB) and Prescription Drug Affordability Council (PDAC) convened to discuss the affordability review and the upper payment limit (UPL) process. The Board disagreed with stakeholder concerns urging the Board to delay the UPL-setting process, reasoning that slowing down would not resolve outstanding questions and highlighting
- [California Attorney General Warns Consumers About Health Care Sharing Ministry Plans](https://aimedalliance.org/california-attorney-general-warns-consumers-about-health-care-sharing-ministry-plans/) - California Attorney General Rob Bonta has issued a warning to consumers about sham health insurance plans offered by some health care sharing ministries (HSMs). HSMs, exempted from some of the Patient Protection and Affordable Care Act mandates, allow people to pool their money with others who have similar religious beliefs, but do not guarantee payment
- [CA Governor Signs Healthcare-AI Laws Establishing New Safeguards](https://aimedalliance.org/ca-governor-signs-healthcare-ai-laws-establishing-new-safeguards/) - California Governor Gavin Newsom signed into law two new healthcare-related artificial intelligence (AI) bills that introduce regulations for payers using AI in coverage decisions and establish rules for AI-generated communications between providers and patients. The first, the “Physicians Make Decisions Act” (SB 1120), requires that AI tools used by insurers in making coverage decisions must
- [Aimed Alliance and NORM Release 2025 Open Enrollment Brochures](https://aimedalliance.org/aimed-alliance-and-norm-release-2025-open-enrollment-brochures/) - The 2025 Open Enrollment period is fast approaching! The 2025 Open Enrollment period of individuals, small group and large group plans begins on November 1, 2024, and ends on December 15, 2024. To ensure consumers are able to select the health plan that is most appropriate for their needs, Aimed Alliance and the National Organization
- [Aimed Alliance Sends Letter of Support for Copay Accumulator Ban in California](https://aimedalliance.org/aimed-alliance-sends-letter-of-support-for-copay-accumulator-ban-in-california/) - On May 8, 2024, Aimed Alliance sent a letter to California Appropriations Committee in support of Assembly Bill 2180 – Ensuring Equitable Copay Practices in California, which aims to ban copay accumulator policies. Copay accumulator policies exclude the value of financial assistance from third parties from counting towards a patient’s deductible or maximum out-of-pocket limit.
- [FTC Files Lawsuit Against Three Major PBMs](https://aimedalliance.org/ftc-files-lawsuit-against-three-major-pbms-2/) - On September 20th, 2024, the Federal Trade Commission (FTC) filed a complaint against Express Scripts, CVS Caremark, and OptumRx – the three pharmacy benefit mangers (PBMs) responsible for administering approximately 80 percent of prescription drugs in the U.S. The complaint alleges the PBMs are inflating insulin prices through anticompetitive practices. In the complaint, the FTC
- [CMS Covers PrEP as Preventative Service](https://aimedalliance.org/cms-covers-prep-as-preventative-service-2/) - On September 30, 2024, the Centers for Medicare & Medicaid Services (CMS) announced its decision to cover all forms of Pre-Exposure Prophylaxis (PrEP) as a preventive service under Medicare Part B without cost-sharing. Previously, PrEP was only covered under Medicare Part D, which required patients to pay substantial out-of-pocket costs to access the medication. However,
- [Aimed Alliance Launches Survey for Employers on Women in Mid-Life](https://aimedalliance.org/aimed-alliance-launches-survey-for-employers-on-women-in-mid-life/) - Aimed Alliance and the HR.com Research Institute are conducting a survey of human resource professionals and employers to better understand how employers view the health care needs of women in menopause, and women in mid-life in the workplace. Who should complete this survey? Employers, human resources professionals, health insurance benefit professionals, or other individuals responsible
- [Analysis Finds that Despite State Laws, Health Plans Still Use Copay Accumulators](https://aimedalliance.org/analysis-finds-that-despite-state-laws-health-insurance-plans-in-10-states-still-use-copay-accumulator-policies-2/) - On August 28, 2024, The AIDS Institute released an analysis revealing that despite laws banning copay accumulator policies, health insurance plans in 10 states still use them. Currently, 18 states and Puerto Rico have laws that require insurers and pharmacy benefit managers to count all payments made by or on behalf of a patient toward
- [Aimed Alliance Comments on the CMS FY 2025 Physician Fee Schedule](https://aimedalliance.org/analysis-finds-that-despite-state-laws-health-insurance-plans-in-10-states-still-use-copay-accumulator-policies/) - On September 9, 2024, Aimed Alliance submitted a comment on the Centers for Medicare & Medicaid Services’ (CMS) 2025 Physician Fee Schedule, expressing support for the inclusion of digital mental health treatment (DMHT) codes and emphasizing the importance of a flexible, patient-centered approach to expanding access to innovative mental health care treatments. In the comment,
- [Aimed Alliance Receives Interim Response to FDA Citizen Petition](https://aimedalliance.org/aimed-alliance-receives-interim-response-to-fda-citizen-petition/) - On August, 28, 2024, Aimed Alliance received an interim response from the Food and Drug Administration regarding its Citizen Petition on alternative funding programs and their use of international importation. Given the nuances of the issue, the FDA stated it was "unable to reach a decision on your petition because it raises complex issues requiring
- [Aimed Alliance Urges CT Governor to Consider PDAB Alternatives](https://aimedalliance.org/aimed-alliance-urges-ct-governor-to-consider-pdab-alternatives/) - On August 27, 2024, Aimed Alliance sent Connecticut Governor Ned Lamont a letter urging the Governor to consider alternatives to establishing a prescription drug affordability board (PDAB) in Connecticut, focusing on solutions that directly improve consumer access and affordability. The letter raises concerns that PDABs are experimental, lack guaranteed savings for consumers, and may lead
- [Aimed Alliance Publishes New Resource on PDAB & IRA Implications for Rare Disorders](https://aimedalliance.org/aimed-alliance-publishes-new-resource-on-pdab-ira-implications-for-rare-disorders/) - On August 20, 2024, Aimed Alliance released a new fact sheet on, "IRA, PDABs, & Orphan Drugs: How Price Setting Mechanisms May Harm Patients with Rare Disorders." This new resource reviews how the Inflation Reduction Act and Prescription Drug Affordability Boards may impact patients with rare disorders in terms of access to treatments as well
- [Analysis Indicates Rising Costs for ACA Plans in 2025](https://aimedalliance.org/analysis-indicates-rising-costs-for-aca-plans-in-2025/) - A new analysis released by KFF Health System Tracker found that insurers participating in ACA-regulated health plans are proposing a median premium increase of seven percent for 2025. The analysis covers 324 insurers across all 50 states and DC, with most proposed premium changes ranging between two and ten percent. Major factors driving premium changes
- [New Study Shows Importance of Clear Prescription Drug Ads](https://aimedalliance.org/new-study-shows-importance-of-clear-prescription-drug-ads/) - According to a new study conducted by the Food & Drug Administration’s Center for Drug Evaluation and Research, confusion may arise when information about a condition is closely advertised with an ad for a prescription drug. Pharmaceutical companies often use disease awareness communications to educate consumers about medical conditions and encourage them to consult healthcare
- [Congress Supports Genetically Targeted Technologies in FY 2025 House Labor-HHS Report](https://aimedalliance.org/congress-supports-genetically-targeted-technologies-in-fy-2025-house-labor-hhs-report/) - On July 9, 2024, the House of Representatives Committee on Appropriations released its Fiscal Year 2025 draft report, which includes important language regarding protecting access to genetic therapies such as antisense oligonucleotides (ASOs). While the IRA exempts drugs from the negotiation process for the first seven years (small molecule—prescription drugs) and eleven years (large molecule—biologics),
- [Advocates Urge CMS to Ensure Coverage of All FDA-Approved PrEP Medications](https://aimedalliance.org/advocates-urge-cms-to-ensure-coverage-of-all-fda-approved-prep-medications/) - On July 17, 2024, 63 organizations dedicated to ending HIV, requested the Centers for Medicaid and Medicare Services (CMS) issue updated guidance to ensure coverage requirements are consistent with the latest U.S. Preventative Services Taskforce (USPSTF) recommendations for HIV Pre-Exposure Prophylaxis (PrEP), which now includes coverage for the first long-acting PrEP treatment. The letter urges
- [Aimed Alliance Joins ERISA Comment to House Committee on Education and the Workforce](https://aimedalliance.org/aimed-alliance-joins-erisa-comment-to-house-committee-on-education-and-workforce/) - Aimed Alliance joined over forty advocacy organizations representing health care consumers and providers jointly submitted a letter on the Employee Retirement and Income Security Act (ERISA) to the House of Representative Committee on Education and the Workforce. The letter responded to Chairwoman Foxx's request for information on ERISA and health insurance coverage. In the letter,
- [NIH Study Demonstrates Risks of AI in Medical Decision Making  ](https://aimedalliance.org/nih-study-demonstrates-risks-of-ai-in-medical-decision-making/) - On July 23, 2024, researchers at the National Institutes of Health (NIH) published a study highlighting the risks and benefits of integrating AI into medical decision-making. The study found that an AI model accurately answered medical quiz questions designed to test health professionals' diagnostic abilities using clinical images and brief text summaries. However, the AI
- [House Committee Report Uncovers Anti-Competitive PBM Practices ](https://aimedalliance.org/house-committee-report-uncovers-anti-competitive-pbm-practices/) - On July 23, 2024, the House Committee on Oversight and Accountability released a report on its investigation into the three largest Pharmacy Benefit Managers (PBMs), revealing significant anti-competitive practices. Key findings include: PBMs share patient data to direct patients to PBM-owned pharmacies, undermining competition. PBMs use their position to lower reimbursement rates for competing
- [HHS Creates New Office to Regulate Safety of AI and Health Technology ](https://aimedalliance.org/hhs-creates-new-office-to-regulate-safety-of-ai-and-health-technology/) - On July 25, 2024, the U.S. Department of Health and Human Services (HHS) announced its decision to increase oversight efforts on artificial intelligence (AI) and health technology by creating the Assistant Secretary for Technology Policy and Office of the National Coordinator for Health Information Technology (ONC). The ONC will include the HHS-wide roles of Chief
- [FDA Announces New Digital Health Advisory Committee Members ](https://aimedalliance.org/fda-announces-new-digital-health-advisory-committee-members/) - On August 1, 2024, the U.S. Food and Drug Administration (FDA) announced the 10 members of its new Digital Health Advisory Committee. The Digital Health Advisory Committee is tasked with advising the FDA on policies related to artificial intelligence(AI)/machine learning, cybersecurity, patient-generated health data, and other digital health technologies. The Committee's first meeting will be
- [Nationwide Survey Results Show Far-Reaching Impacts of Chronic Diseases](https://aimedalliance.org/nationwide-survey-results-show-far-reaching-impacts-of-chronic-diseases/) - The Chronic Disease Coalition recently conducted a survey of over 1,000 individuals living with chronic diseases, revealing the extensive financial, professional, and emotional challenges that come with managing a chronic condition. The findings showed that 29 percent of respondents admitted to having to choose between their medication and other basic necessities, like rent, food, or
- [New Recovery Friendly Workplace Certification for Employers](https://aimedalliance.org/new-recovery-friendly-workplace-certification-for-employers/) - The National Recovery Friendly Workplace Institute has created a national Recovery Friendly Workplace certification program for employers. The Recovery Friendly Workplace definition and certification standards were developed by a diverse group of experienced stakeholders, including Counsel to Aimed Alliance, Michael C. Barnes, Esq.; and representatives from the White House Office of National Drug Control Policy, the
- [Advocates Urge Governor Hochul to Pass Step Therapy Guardrails](https://aimedalliance.org/advocates-urge-governor-hochul-to-pass-step-therapy-guardrails/) - On July 19, 2024, Aimed Alliance and ten other advocacy organizations sent a letter to Governor Hochul urging her to swiftly sign legislation that would create new and improved step-therapy guardrails for New York consumers. Specifically, A.901(a)/S.1267(a) would prohibit individuals from trying and failing on off-label treatments; limit steps to no more than two in
- [Oregon PDAB Meeting Highlights Diverse Perspectives on UPLs](https://aimedalliance.org/oregon-pdab-meeting-highlights-diverse-perspectives-on-upls/) - On July 24, 2024, the Oregon Prescription Drug Affordability Board (PDAB) held seven panels related to upper payment limits (UPLs), with each panel addressing 1-2 key questions from the Board. The first panel focused on patients and consumers, with a patient sharing his experience with high out-of-pocket costs and highlighting duplicative expenses in healthcare. The
- [IRA May Not Lower Medicare Part D Out-of-Pocket Costs](https://aimedalliance.org/ira-may-not-lower-medicare-part-d-out-of-pocket-costs/) - A new analysis found that the Inflation Reduction Act (IRA) could raise out-of-pocket costs for 3.5 million Medicare Part D beneficiaries in 2026. This could undermine the new $2,000 annual out-of-pocket cap meant to benefit seniors and people with disabilities. According to the Milliman analysis, beneficiaries using medicines subject to a maximum fair price could
- [CMS Proposes Permanent Reimbursement for Audio-Only Telehealth Services](https://aimedalliance.org/cms-proposes-permanent-reimbursement-for-audio-only-telehealth-services/) - On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) proposed to make physician reimbursement for audio-only telehealth services permanent. This decision, part of the proposed 2025 Physician Fee Schedule, marks a significant development for rural patients who often have less access to broadband internet compared to urban patients, and some of which
- [CMS Proposes No-Cost Hepatitis B Vaccinations for Medicare Beneficiaries](https://aimedalliance.org/cms-proposes-no-cost-hepatitis-b-vaccinations-for-medicare-beneficiaries/) - In the 2025 Medicare Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) proposed offering consumers no-cost hepatitis B vaccinations for individuals who have not completed a hepatitis B vaccination series or whose vaccination history is unknown. Hepatitis B is a vaccine-preventable communicable disease of the liver. If finalized, the proposal would eliminate
- [Senate Appropriations Committee Advances FY 2025 Funding Bill with Focus on Rare Disease and AI](https://aimedalliance.org/senate-appropriations-committee-advances-fy-2025-funding-bill-with-enhanced-fda-directives-and-increased-funding/) - On July 11, 2024, the Senate Appropriations Committee met for a full committee markup and approved subcommittee allocations for the Fiscal Year 2025 Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act. The Committee advanced the funding bill in a bipartisan vote, which includes a $22 million increase in discretionary funding for
- [CMS Proposes New Codes for Medicare Reimbursement of Digital Therapeutics in Mental Health Treatment](https://aimedalliance.org/cms-proposes-new-codes-for-medicare-reimbursement-of-digital-therapeutics-in-mental-health-treatment/) - The Centers for Medicare & Medicaid Services (CMS), in its draft 2025 physician fee schedule, proposed adding three new HCPCS codes for digital therapeutics (DTx) used in mental health treatment. This move represents the first step toward Medicare reimbursement for DTx. The proposed codes are: GMBT1: For reimbursing physicians providing FDA-approved DTx devices for mental
- [New Report Provides Policy Recommendations to Next Administration on AI Regulation](https://aimedalliance.org/new-report-provides-policy-recommendations-to-next-administration-on-ai-regulation/) - On July 3, the MITRE, a non-profit company that provides technical expertise on a variety of technology subject matters, released policy recommendations on artificial intelligence (AI) for the incoming White House administration. According to the report, given the swift evolution of AI technology, the any new Administration must remain updated on the latest developments in
- [FDA and FTC Target Illegal Delta-8 THC Copycat Foods](https://aimedalliance.org/fda-and-ftc-target-illegal-delta-8-thc-copycat-foods/) - On July 16, 2024, the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) issued warning letters to five companies for illegally selling copycat food products containing delta-8 THC, in violation of the Federal Food, Drug, and Cosmetic Act. These products are especially concerning because their packaging closely mimics popular snacks, increasing
- [New White Paper Explains Why AFP Savings May Fall Short of Expectations](https://aimedalliance.org/new-white-paper-explains-why-afp-savings-may-fall-short-of-expectations/) - A new White Paper titled "Pharmacy Benefit Alternative Funding Programs: Key Considerations for Self-Funded Plan Sponsors" details how the saving alleged from alternative funding programs may actually be lower than initially anticipated due to factors such as lost rebate revenue, PAP ineligibility, and increased administrative fees. The White Paper also highlights several potential compliance risks
- [FTC Report Unveils PBM Impact on Drug Costs and Accessibility](https://aimedalliance.org/ftc-report-unveils-pbm-impact-on-drug-costs-and-accessibility/) - On July 9, 2024, the Federal Trade Commission (FTC) released an interim report highlighting the significant impact of pharmacy benefit managers (PBMs) on the accessibility and affordability of prescription drugs. The report, part of an ongoing inquiry since 2022, reveals that the top three PBMs process nearly 80 percent of prescription drugs in U.S (the
- [Aimed Alliance Submits Comment in Support of CO PDAB Rare Disease Carveout](https://aimedalliance.org/aimed-alliance-submits-comment-in-support-of-co-pdab-rare-disease-carveout/) - On April 4, 2024, Aimed Alliance submitted a letter of support to the Colorado General Assembly urging the Committee to swiftly pass SB24-060, which would exempt Orphan Drugs from PDAB considerations. The letter supported exempting orphan drugs from affordability reviews and price setting, as this would help safeguard access, research, and investment in these treatments
- [Aimed Alliance Provides Comment on Medicare Drug Price Negotiation Program Guidance](https://aimedalliance.org/aimed-alliance-provides-comment-on-medicare-drug-price-negotiation-program-guidance/) - On July 2, 2024, Aimed Alliance submitted a comment to the Centers for Medicare & Medicaid Services (CMS) regarding the Medicare Drug Price Negotiation Program Guidance. Aimed Alliance urged CMS to ensure their listening process is genuine, inclusive, and effective. Key recommendations included providing clear guidance for listening sessions, promoting diversity through varied session times
- [Aimed Alliance Releases New PDAB Fact Sheet: Challenges and Alternatives](https://aimedalliance.org/aimed-alliance-releases-new-pdab-fact-sheet-challenges-and-alternatives/) - On May 31, 2024, Aimed Alliance released a new fact sheet on prescription drug affordability boards (PDABs). The new resource titled "PRESCRIPTION DRUG AFFORDABILITY BOARDS: Challenges & Alternatives" reviews recent challenges with PDABs such as quantitative and qualitative analysis values; impact on consumer affordability; and logistical challenges with PDABs. In addition, the resource recognizes alternatives
- [Oregon PDAB Postpones Drug Reviews Until 2025](https://aimedalliance.org/oregon-pdab-postpones-drug-reviews-until-2025/) - On June 26, 2024, the Oregon Prescription Drug Affordability Board (PDAB) voted to pause all ongoing drug reviews for the remainder of the year and postpone additional reviews until 2025. This decision, proposed by Oregon Board Chair Shelley Bailey, aims to address issues that have arisen during this year’s drug review process. These include the
- [Oklahoma Seeks Supreme Court Review of Tenth Circuit Ruling on State PBM Regulation](https://aimedalliance.org/oklahoma-seeks-supreme-court-review-of-tenth-circuit-ruling-on-state-pbm-regulation/) - The Tenth Circuit Court of Appeals, in Pharmaceutical Care Management Association (PCMA) v. Mulready, struck down certain provisions in the Patient’s Right to Pharmacy Choice Act, an Oklahoma law designed to ensure adequate pharmacy network access and prohibit pharmacy benefit managers (PBMs) from directing patients to PBM-affiliated pharmacies exclusively PCMA, an association representing PBMs, argued
- [Surgeon General Declares Firearm Violence a Public Health Crisis](https://aimedalliance.org/surgeon-general-declares-firearm-violence-a-public-health-crisis/) - On June 25, 2024, U.S. Surgeon General Dr. Vivek Murthy issued an Advisory on firearm violence, declaring it a public health crisis. Over the past decade, deaths from firearm-related injuries, including suicides, homicides, and accidental shootings, have been rising. Firearm violence is now the leading cause of death among children and adolescents. Nearly 60 percent
- [AFP Taskforce Sends Letter to HHS Regarding Upcoming Rulemaking](https://aimedalliance.org/afp-taskforce-sends-letter-to-hhs-regarding-upcoming-2025-nbpp-rulemaking/) - On May 31, 2024, Aimed Alliance joined 19 other members of the Alternative Funding Program Taskforce to send a letter to the Department of Health and Human Services, Department of Labor, and Department of Treasury regarding the upcoming 2025 NBPP rulemaking. The letter urges the tri-agencies to ensure the non-essential health benefit justification is closed
- [Congress Re-Introduces Bill to Streamline Medicare Advantage Prior Authorizations](https://aimedalliance.org/congress-re-introduces-bill-to-streamline-medicare-advantage-prior-authorizations/) - On June 12, House and Senate leaders reintroduced the bipartisan Improving Seniors’ Timely Access to Care Act which is aimed at streamlining prior authorization requirements for Medicare Advantage plans. This bill aims to expedite access to necessary treatments by proposing an electronic system for prior authorizations, reducing approval times, mandating reporting on prior authorization usage
- [Aimed Alliance Advocates for Step Therapy Reform to Protect NY Patients](https://aimedalliance.org/aimed-alliance-advocates-for-reform-to-protect-ny-patients-from-harmful-step-therapy-policies/) - The New York Step Therapy Alliance, led by Aimed Alliance, is championing a step-therapy reform bill, A.901, to ensure patients receive appropriate care without unnecessary delays and barriers. Step therapy policies, also known as “fail-first,” can harm patients by requiring them to try alternative medications before insurers will cover the initially prescribed treatment. In a
- [Aimed Alliance Urges CMS to Collect Comprehensive Data from Medicare Advantage Plans](https://aimedalliance.org/aimed-alliance-urges-cms-to-collect-comprehensive-data-from-medicare-advantage-plans/) - On May 29, 2024, Aimed Alliance submitted a response to the Centers for Medicare & Medicaid Service’s (CMS) request for information regarding Medicare Advantage (MA) data. The comment discussed concerns regarding the utilization of prior authorization and step therapy in MA plans, such as high denial rates and high overturn rates on appeal. To better
- [Aimed Alliance to Moderate Panel at BIO International 2024 Conference](https://aimedalliance.org/aimed-alliance-to-moderate-panel-at-bio-international-2024-conference/) - Join Aimed Alliance at the 2024 BIO International Conference for a panel discussion on "Alternative Funding Programs: Protecting Patients in an Ever-Changing Healthcare Landscape". Summary: The healthcare landscape in the United States has witnessed a profound transformation in recent years, particularly concerning patient cost-sharing. This session will shed light on alternative funding programs, which have
- [FDA Commissioner Advocates for New Regulatory Pathway for Cannabis Products](https://aimedalliance.org/fda-commissioner-advocates-for-new-regulatory-pathway-for-cannabis-products/) - On May 7, the Food and Drug Administration (FDA) Commissioner Robert Califf called on Congress to collaborate with the FDA to create a better regulatory pathway for cannabis products. The Commissioner underscored the need for systematic regulation to ensure harm reduction, citing safety concerns with ingestible cannabinoid products like Delta-8 THC gummies. This call aligns
- [NYT Opinion Video: Denying Your Health Care Is Big Business in America](https://aimedalliance.org/nyt-opinion-video-denying-your-health-care-is-big-business-in-america/) - A recent New York Times opinion piece interviewed over fifty doctors and patients regarding how prior authorization has impacted their access to care. The video highlights the challenges providers experience with prior authorizations and the impact that delays in care have by highlighting the stories of Ocean, Michael, and Vivian, all individuals who experienced serious
- [Upcoming Webinar May 10 on Medicare Advantage Reform](https://aimedalliance.org/upcoming-webinar-may-10-on-medicare-advantage-reform/) - Join Aimed Alliance and the National Minority Quality Forum on May 10, 2024 at 12PM ET for a Webinar on Medicare Advantage Reform In 2023, Medicare Advantage plans provided coverage for up to 30.8 million individuals, constituting over half of Medicare-eligible lives.[1] Medicare Advantage plans also continue to represent an increasingly diverse percentage of the
- [Aimed Alliance & NMQF Host Webinar on Medicare Advantage Reform](https://aimedalliance.org/aimed-alliance-hosts-nmqf-webinar-on-medicare-advantage-reform/) - On May 10, 2024, Aimed Alliance and the National Minority Quality Forum (NMQF) hosted a webinar on Medicare Advantage Reform. View the webinar below.
- [Prescription for Success: Navigating the Risks of AFPs for Employers and Employees](https://aimedalliance.org/prescription-for-success-navigating-the-risks-of-afps-for-employers-and-employees/) - HR.com recently published an article authored by Josie Cooper, Executive Director of the Alliance for Patient Access (AfPA), regarding the risks of alternative funding programs (AFPs) for employers and employees. The article explains how AFPs work with employers and how employers view these programs. The article highlights several key findings from the Aimed Alliance, AfPA,
- [CVS NMS Letter - Depression Medications](https://aimedalliance.org/cvs-nms-letter-depression-medications/) - November 23, 2020 Troyen Brennan Executive Vice President, Chief Medical Officer CVS Health troyen.brennan@cvshealth.com Sreekanth Chaguturu Chief Medical Officer CVS Health sree.chaguturu@cvshealth.com Re: Formulary Coverage of Selective Serotonin Reuptake Inhibitors Dear Dr. Brennan and Dr. Chaguturu: The undersigned organizations write to request that CVS Caremark allow stable patients to remain on their current selective serotonin
- [Upcoming: Aimed Alliance Joins Panelists for "Coffee Chat" on AFPs](https://aimedalliance.org/upcoming-coffee-chat-with-aimed-alliance-on-afps/) - Join the BIO Patient Advocacy Coffee Chat and Aimed Alliance on April 17, 2024 from 9:00AM-10:00AM ET as panelists discuss Patients Under Pressure - From A(FPs) to Z. Patients continue to face increasing pressure when it comes to getting access to medicines. From alternative funding programs (AFPs), to increased utilization management, step therapy, PBMs, implications
- [CMS Releases Final 2025 Medicare Advantage and Part D Rule](https://aimedalliance.org/cms-releases-final-2025-medicare-advantage-and-part-d-rule/) - On April 4, 2024, the Centers for Medicare and & Medicaid Services (CMS) announced its final 2025 Medicare Advantage and Part D Rule. The final rule includes several important revisions to improve the Medicare Advantage program, such as placing a fixed limit on compensation for agents and brokers to address problematic incentives created under the
- [Study Finds CBD Inneffective for Chronic Pain Management](https://aimedalliance.org/study-finds-cbd-inneffective-for-chronic-pain-management/) - A new study published in The Journal of Pain found that cannabidiol (CBD) was ineffective in treating chronic pain. The study analyzed 16 randomized double-blind trials encompassing over 900 participants, and found that CBD yielded no greater pain-relieving effect compared to a placebo. Beyond efficacy concerns, there are also concerns regarding the considerable variability in
- [GAO Report Reveals Over $100 Billion in Improper Payments for Medicare and Medicaid in 2023](https://aimedalliance.org/gao-report-reveals-over-100-billion-in-improper-payments-for-medicare-and-medicaid-in-2023/) - On March 26, 2024, the Government Accountability Office’s (GAO) published its latest report on improper payments, which are payments that should not have been made or were made in the incorrect amount. According to the report, traditional Medicare, Medicare Advantage, and Part D reported an estimated $51.1 billion in improper payments in 2023. Medicaid closely
- [Aimed Alliance Submits Citizen Petition to the FDA on Alternative Funding Programs](https://aimedalliance.org/aimed-alliance-submits-citizen-petition-to-the-fda-on-alternative-funding-programs/) - On March 1, 2024, Aimed Alliance submitted a Citizen Petition to the Food and Drug Administration (FDA) regarding international importation by alternative funding programs. The Petition asks the FDA to clarify (1) whether third-party companies that partner with employer-sponsored health plans can legally require employees to import their prescription drugs from outside the United States;
- [Aimed Alliance Submits Letter of Support for Biomarker Legislation](https://aimedalliance.org/aimed-alliance-submits-letter-of-support-for-biomarker-legislation/) - Aimed Alliance recently submitted letters of support to the Washington and Iowa legislatures urging them to swiftly pass biomarker legislation to ensure consumers have access to these necessary and informative tests. Biomarker testing plays a pivotal role in gathering personalized information essential for the disease prevention, diagnosis, and treatment. By analyzing biological specimens such as
- [Executive Order Bolsters Research for Women's Health in Mid-Life](https://aimedalliance.org/executive-order-bolsters-womens-health-research-and-funding/) - On March 18, 2024, President Biden signed an Executive Order that accelerates research and funding efforts to advance women’s health. The Order focuses on integrating and prioritizing women’s health across various federal agencies’ research portfolios and budgets. Key directives include instructing the Department of Health and Human Services to expand data collection efforts related to
- [Biden Administration Announces to New Rule to Protect Consumers from Junk Health Plans](https://aimedalliance.org/biden-administration-announces-to-new-rule-to-protect-consumers-from-junk-health-plans/) - On March 28, 2024, the Biden administration announced it was finalizing a new rule restricting short-term health plans to a 90-day limit, extendable by one-month, effectively overturning a Trump-era policy allowing short-term health plans to be valid for up to three years. Junk insurance are misleading for consumers as these plans often lack comprehensive coverage
- [Aimed Alliance's New Report on AFPs: Navigating Today’s Pharmacy Benefits Efficiently, Effectively, and Ethically](https://aimedalliance.org/aimed-alliances-new-report-on-afps-navigating-todays-pharmacy-benefits-efficiently-effectively-and-ethically/) - The rising cost of healthcare, and prescription drugs in particular, is a source of anxiety for employers with each new plan year. While there are multiple reasons for this increase, including the growing demand for specialty drugs, it is essential that employers gain a deeper understanding of the emerging trends that are being suggested to
- [Aimed Alliance Hosts Webinar on "Prescription Drug Affordability Boards 101: Everything You Need to Know"](https://aimedalliance.org/aimed-alliance-hosts-webinar-on-prescription-drug-affordability-boards-101-everything-you-need-to-know/) - On March 18, 2024, Aimed Alliance hosted a webinar on Prescription Drug Affordability Boards (PDABs) titled "PDAB 101: Everything You Need to Know". View the webinar below.
- [Aimed Alliance and AfPA host HR.com Webinar on Health Benefits: The Hidden Cost of "Cost-Saving Programs"](https://aimedalliance.org/aimed-alliance-and-afpa-host-hr-com-webinar-on-health-benefits-the-hidden-cost-of-cost-saving-programs/) - On Oct. 20, 2022, Aimed Alliance and the Alliance for Patient Access hosted a webinar on HR.com titled Health Benefits: The Hidden Cost of "Cost-Saving" Programs.
- [Advocates File Complaints Alleging ADA Violations in State Medicaid Renewal Processes](https://aimedalliance.org/advocates-file-complaints-alleging-ada-violations-in-state-medicaid-renewal-processes/) - Healthcare advocacy groups, including the National Health Law Program, have filed administrative complaints against the Department of Health and Human Services’ Office for Civil Rights and the Department of Justice alleging that the Medicaid redetermination process in Washington D.C., Texas, and Colorado are violating the Americans with Disabilities Act (ADA). The complaints allege these state
- [Biden’s FY 2025 Budget Prioritizes Healthcare, Family Wellbeing, and Scientific Research](https://aimedalliance.org/bidens-fy-2025-budget-prioritizes-healthcare-family-wellbeing-and-scientific-research/) - In March 2023, the Biden-Harris Administration released it’s FY2025 budget proposals to broaden healthcare coverage and access; and improve health outcomes. Building on initiatives like the Inflation Reduction Act of 2022, the proposed budget would expand the drug price negotiation program to at least 500 drugs over the next ten years, and cap insulin costs
- [Aimed Alliance Comments on Oregon's PDAB Process](https://aimedalliance.org/aimed-alliance-comments-on-oregons-pdab-process/) - On February 25, 2024, Aimed Alliance sent a letter to the Oregon Prescription Drug Affordability Board regarding its current patient engagement process. Specifically, our letter urged for a clearer patient engagement process, valuing lived experiences, and protecting access to rare disease treatments. Read Aimed Alliance’s letter here.
- [Florida Bill to Regulate Hemp-Derived Products Advances](https://aimedalliance.org/florida-bill-to-regulate-hemp-derived-products-advances/) - The Florida Senate recently voted to restrict the sale of intoxicating cannabinoid products. SB 1698 addresses health and safety concerns associated with these consumer products by limiting the levels of intoxicating THC in hemp-extract products. Specifically, it targets delta-8, delta-9, and delta-10 THC, among other cannabinoids, identifying them as controlled substances. In addition, the bill
- [New Resources for Consumers & Employers: DC Decision Bans Copay Accumulators](https://aimedalliance.org/new-resources-for-consumers-employers-dc-decision-bans-copay-accumulators/) - On September 29, 2023, the United States District Court for the District of Columbia held that the 2021 NBPP, which permitted the use of copay accumulators, would be set aside because it was arbitrary and capricious. As a result of the 2021 NBPP being set aside, the law reverts to the requirements in the 2020
- [UPCOMING WEBINAR: Prescription Drug Affordability Boards 101](https://aimedalliance.org/upcoming-webinar-prescription-drug-affordability-boards-101/) - Join Aimed Alliance for a FREE webinar on March 18, 2024 at 11AM ET – 12:00PM ET. Ensuring prescription drug affordability continues to be a top concern for consumers, caregivers, and policymakers. To address these concerns, state and federal legislators have taken action by enacting a variety of laws that would set limits on certain prescription
- [Aimed Alliance and PACH host HR.com Webinar on: Non-Medical Switching: The Harmful and Unintended Consequences Affecting Patients](https://aimedalliance.org/aimed-alliance-speaks-at-healthywomens-cures-2-0-virtual-policy-discussion-2/) - On June 7, 2022, Aimed Alliance and the Partnership to Advance Cardiovascular Health hosted a webinar on HR.com titles "Non-Medical Switching: The Harmful and Unintended Consequences Affecting Patients." View the webinar below. https://www.youtube.com/watch?v=RkwlJcGckE4
- [FDA Guidance Emphasizes Patient Engagement in Rare Disease Drug Development](https://aimedalliance.org/fda-guidance-emphasizes-patient-engagement-in-rare-disease-drug-development/) - The FDA recently released updated guidance, titled “Rare Diseases: Considerations for the Development of Drugs and Biological Products,” emphasizing the importance of engaging patient and caregiver populations in the development of drugs for rare diseases. This final version builds upon draft guidance issued in February 2019, offering recommendations for sponsors developing drugs for rare diseases.
- [NEW White Paper on Alternative Funding Programs](https://aimedalliance.org/new-white-paper-on-alternative-funding-programs/) - In recent years, the adoption of alternative funding programs (AFPs) among self-funded employer-sponsored plans has risen rapidly. However, few employers realize that AFPs can harm employee health and may deplete essential resources for truly underinsured or uninsured patients. In response, Aimed Alliance has collaborated with nine other advocacy groups to coauthor a new white paper,
- [Study Finds 340B Hospitals Significantly Markup Infusion Drugs](https://aimedalliance.org/study-finds-340b-hospitals-significantly-markup-infusion-drugs/) - A recent study published in the New England Journal of Medicine examined the pricing practices of hospitals participating in the 340B drug discount program, revealing significant markups on doctor-administered infusion drugs compared to independent practices and non-340B hospitals. Utilizing claims data from Blue Cross Blue Shield spanning 2020-2021, the research found significant disparities in price
- [Senators Seek Input on Draft 340B Reform Bill](https://aimedalliance.org/senators-seek-input-on-draft-340b-reform-bill/) - The Senate 340B Working Group is soliciting additional stakeholder input on key longstanding issues surrounding the Medicare 340B program. The discussion bill aims at clarifying the program’s intent in several key areas such as: (1) Contract Pharmacies The proposed bill would establish statutory clarity regarding how contract pharmacies partner with covered entities to dispense 340B
- [MDPC’s New Policy Paper on Parkinson’s Disease Care Access](https://aimedalliance.org/mdpcs-new-policy-paper-on-parkinsons-disease-care-access/) - This month, the Movement Disorder Policy Coalition (MDPC) released a new policy paper, “Parkinson’s Disease: Improving Treatment While Working Toward a Cure.” Authored by physicians, this paper sheds light on critical opportunities for policymakers to enhance care for individuals living with Parkinson’s disease. It addresses access barriers such as scarcity of specialty care, health plan
- [Aimed Alliance Submits Comment on 2025 Medicare Part D Rule](https://aimedalliance.org/aimed-alliance-submits-comment-on-2025-medicare-part-d-rule/) - On January 5, 2024, Aimed Alliance submitted a comment on the Medicare Program Contract Year 2025 proposal. The comment expressed concerns regarding CMS' proposed decision to automatically permit plans to switch consumers from a biologic to a biosimilar, irrespective of the drug's interchangeability designation. Read the comment here.
- [Aimed Alliance Submits Comment on 2025 NBPP](https://aimedalliance.org/aimed-alliance-submits-comment-on-2025-nbpp/) - On January 8, 2024, Aimed Alliance submitted a comment to the Centers for Medicare and Medicaid Services (CMS) on the proposed 2025 Notice of Benefit and Payment Parameters (NBPP). Our comment urged CMS to clarify the scope of EHB coverage requirements; finalize network adequacy standards; and require P&T committees to include a consumer representative. Read
- [Senate Pushes for FTC Progress in PBM Investigation](https://aimedalliance.org/senate-pushes-for-ftc-progress-in-pbm-investigation/) - Senate Commerce Committee leaders, Maria Cantwell and Chuck Grassley, along with 12 lawmakers, are requesting an update from the Federal Trade Commission (FTC) on its investigation into the impact of pharmacy benefit managers (PBMs) on consumer drug costs. After 18 months of inquiry, the senators sent a letter to the FTC emphasizing the importance of
- [“Plan E”: A Proposal for a Universal Benefit for Cell and Gene Therapies](https://aimedalliance.org/plan-e-a-proposal-for-a-universal-benefit-for-cell-and-gene-therapies/) - Cell and gene therapies (CGTs) have provided new optimism for patients living with diseases previously considered untreatable. These groundbreaking treatments involve introducing genetic material to the targeted cells in the body to treat diseases through various mechanisms, including by enhancing the production of healthy proteins or reducing the production of disease-causing ones. Despite their potential,
- [Aimed Alliance Release New Resources on PDABs](https://aimedalliance.org/aimed-alliance-release-new-resources-on-pdabs/) - On January 22, 2024, Aimed Alliance published two new resources on prescription drug affordability boards (PDABs). These boards, established at the state level, aim to combat the escalating costs of prescription drugs. PDABs employ a range of strategies, including monitoring drug prices, implementing price controls, conducting data analysis, reporting on pricing trends and drug markets,
- [HHS’s 2021 NBPP Rule and Copay Accumulators](https://aimedalliance.org/hhss-2021-nbpp-rule-and-copay-accumulators/) - Brief Summary: This lawsuit challenges the U.S. Department of Health and Human Services (HHS) 2021 Notice of Benefit Payment and Parameters (NBPP) that permitted health plans to adopt copay accumulator programs by allowing plans to apply their own definition of cost-sharing. Overview: When privately insured patients cannot afford their medications, they may rely on financial
- [Canadians Express Concerns Regarding Florida's Importation Program](https://aimedalliance.org/canadians-express-concerns-regarding-floridas-importation-program/) - Florida's plan to import prescription drugs from Canada is facing a potential setback as Canadian officials are expressing concerns about safeguarding their pharmaceutical supply chain. Specifically, Canadian officials are expressing concerns that importation of Canadian prescription drugs to the United States will impose barriers on Canadians accessing their medications. This has resulted in Canadian officials
- [Aimed Alliance Releases Know Your Rights: Alternative Funding Programs](https://aimedalliance.org/aimed-alliance-releases-know-your-rights-alternative-funding-programs/) - On December 13, 2023, Aimed Alliance published a new resource Know Your Rights: Alternative Funding Programs. Alternative funding programs (AFPs) are third-party companies that partner with employer-sponsored health plans to identify alternative sources for the plan's specialty drug benefits. These alternative sources can include patient assistance programs (PAPs), copay assistance programs, and importation from international pharmacies.
- [Know Your Rights Limited Formularies](https://aimedalliance.org/know-your-rights-limited-formularies/) - On December 15, 2023 Aimed Alliance published a new resource titled Know Your Rights: Limited Formularies. Under the Patient Protection and Affordable Care Act (ACA) health plans offering essential health benefits are required to provide a process to plan enrollees to ensure they can receive access to non-formulary treatments that are deemed medically necessary. However,
- [Conscious Uncoupling: Walmart and CVS to Part Ways](https://aimedalliance.org/conscious-uncoupling/) - Walmart and CVS have been working together to offer commercial and Medicare Part D prescription coverage, but the two businesses have decided to abandon the partnership after failing to agree on pricing terms. Derica Rice, president of CVS, issued a statement criticizing Walmart’s motivations: “At a time when everyone is working hard to find ways
- [Massachusetts Insurer Agrees to End Discrimination Against Applicants Who Take Preventive Medication for HIV/AIDS](https://aimedalliance.org/massachusetts-insurer-agrees-to-end-discrimination-against-applicants-who-take-preventive-medication-for-hiv-aids/) - Mutual of Omaha, an insurer in Massachusetts, has been denying patients life insurance and long-term care insurance if they take preventive medicine for HIV/AIDS. In two legal settlements, one with the Attorney General of Massachusetts and another with an unnamed plaintiff who was represented by GLBTQ Advocates and Defenders (GLAD), Mutual of Omaha has agreed
- [Drug Price Controls Rejected by Ohio Voters](https://aimedalliance.org/drug-price-controls-rejected-ohio-voters/) - On November 7, Ohio voters rejected by nearly 80 percent a ballot proposal called the Ohio Drug Price Relief Act. The proposal would have required state agencies to pay no more for drugs than the U.S. Department of Veterans Affairs, which receives a 24 percent discount on manufacturers' average drug prices. Voters reported being unclear
- [HHS Sec. Azar Inconsistent on Step Therapy Policies](https://aimedalliance.org/hhs-sec-azar-inconsistent-on-step-therapy-policies/) - Yesterday, the Secretary of the Department of Health and Human Services (HHS), Alex Azar, spoke at the American Medical Association’s (AMA) Advocacy Conference. Sec. Azar declared in his remarks that HHS is interested in taking a closer look at how step therapy is used in the private insurance market. He focused on instances where patients
- [Why Congress and the FDA Must Regulate CBD Consumer Products Now](https://aimedalliance.org/why-congress-and-the-fda-must-regulate-cbd-consumer-products-now/) - On January 3, 2024, CareTalk published an opinion piece authored by Michael C. Barnes, Counsel to Aimed Alliance. The article explains that the CBD consumer product market is largely unregulated, and consumers have no way to be sure that the product they buy contains the ingredients listed on the label -- and that it does
- [Navigating the Future of Digital Therapeutics: CMS's Emerging Technologies Pathway](https://aimedalliance.org/navigating-the-future-of-digital-therapeutics-cmss-emerging-technologies-pathway/) - In the realm of digital therapeutics, the health care landscape is poised for potential transformation as the Centers for Medicare and Medicaid Services (CMS) could reshape the regulatory environment with its new coverage pathway. CMS's new pathway Transitional Coverage for Emerging Technologies (TCET) aims to expedite Medicare coverage for FDA-approved breakthrough devices. The voluntary TCET
- [Aimed Alliance Publishes New Article in CONQUER Magazine on CBD and Consumer Safety](https://aimedalliance.org/aimed-alliance-publishes-new-article-in-conquer-magazine-on-cbd-and-consumer-safety/) - On January 9, 2023, CONQUER Magazine published a piece written by Michael Barnes, Counsel to Aimed Alliance. CONQUER is a forum for patients with cancer, initiated by the Academy of Oncology Nurse & Patient, featuring articles and resources written by and for patients with cancer, survivors, nurse navigators, and other oncology team members. The article
- [CMS Finalizes Electronic Prior Authorization Rule](https://aimedalliance.org/cms-finalizes-electronic-prior-authorization-rule/) - On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule, establishing new requirements for specific payers to streamline prior authorization processes. Effective in 2026, the rule requires impacted payers to respond to expedited (i.e. urgent) prior authorization requests within 72 hours and standard (i.e.,
- [CBO Responds to Calls from the House Budget Committee to Consider New Data on IRA Impact on Innovation](https://aimedalliance.org/cbo-responds-to-calls-from-the-house-budget-committee-to-consider-new-data-on-ira-impact-on-innovation/) - Responding to inquiries from the House Budget Committee, the Congressional Budget Office (CBO) has signaled its openness to examining new data concerning the potential impact of the Inflation Reduction Act’s price negotiation provisions on pharmaceutical innovation. In November 2023, the House Budget Committee, expressed concerns regarding CBO’s analysis and model related to policies impacting new
- [FDA Authorizes Florida's Drug Importation Program](https://aimedalliance.org/fda-authorizes-floridas-drug-importation-program/) - On January 5, 2024, the U.S. Food and Drug Administration (FDA) approved Florida’s Agency for Health Care Administration drug importation program under section 804 of the Federal Food, Drug, and Cosmetic Act (FD&C Act). This is the first approval of its kind. Section 804 of the FD&C Act empowers FDA to approve importation of eligible prescription
- [Aimed Alliance Press Releases](https://aimedalliance.org/press-releases/) - Sign up for our mailing list. Review past press releases below.
- [DC Court Clarifies 2020 NBPP Is Current Law](https://aimedalliance.org/dc-court-clarifies-2020-nbpp-is-current-law/) - On December 22, 2023, the US District Court for the District of Columbia issued an Order clarifying the scope of its September 2023 Decision which vacated the 2021 NBPP. While the September 2023 Decision vacated the 2021 NBPP it did not state what the governing law was in light of the 2021 NBPP’s revocation. Thus,
- [Governor Hochul Signs Bill to Improve Consumer Information](https://aimedalliance.org/governor-hochul-signs-bill-to-improve-consumer-information-in-benefit-denial/) - Governor Hochul has signed A.463A/S.2677! Next year plans will be required to include in an adverse determination letter: (1) instructions on how to initiate standard and expedited appeals; (2) notice of the availability, upon request of the enrollee, or the enrollee's designee, of the clinical review criteria relied upon to make such determination; (3) what,
- [Aimed Alliance Urges CMS to Protect Medicare Advantage Consumers From Double-Step Fail-First Policies](https://aimedalliance.org/aimed-alliance-urges-cms-to-protect-medicare-advantage-consumers-from-double-step-fail-first-policies/) - On December 13, 2023, Aimed Alliance sent a letter to CMS urging it to place guardrails on step therapy policies in Medicare Advantage Plans. Step-therapy policies, often known as “fail first,” require patients to try and fail on alternative treatments, sometimes causing adverse effects, before the plan will cover the originally prescribed treatment. Such policies
- [Urgent Calls for Federal Oversight of Hemp-Derived Cannabinoids Amid Rising Child Hospitalizations](https://aimedalliance.org/urgent-calls-for-federal-oversight-of-hemp-derived-cannabinoids-amid-rising-child-hospitalizations/) - In a recent article, the Wall Street Journal highlights how hundreds of children are being rushed to hospitals after unintentionally consuming THC products. The lack of federal regulations governing the production and accessibility of hemp-derived cannabinoids has allowed manufacturers to deceptively market intoxicating products as harmless. While some states have attempted to regulate these products,
- [House Budget Committee Questions CBO’s Analysis of the IRA’s Impact on Drug Development](https://aimedalliance.org/house-budget-committee-questions-cbos-analysis-of-the-iras-impact-on-drug-development/) - On November 20, 2023, the House Budget Committee addressed a letter to the Congressional Budget Office (CBO), expressing concerns and seeking clarification regarding their analysis and model related to policies impacting new drug development in the United States. The concern stems from the CBO's projection of the IRA’s impact on drug innovation – projecting a
- [New York DFS Withdraws Comprehensive PBM Regulations](https://aimedalliance.org/new-york-dfs-withdraws-comprehensive-pbm-regulations/) - Recently, the New York Department of Financial Services (DFS) withdrew a proposed regulatory package aimed at overseeing the activities of pharmacy benefit managers (PBMs), and simultaneously announced its’ finalization of separate regulations related to PBM licensing. DFS's efforts to regulate PBMs originated from legislation enacted in 2021, and subsequently amended in 2022, which tasked DFS
- [From Farm Bill to FDA: The Legal Landscape of CBD](https://aimedalliance.org/from-farm-bill-to-fda-the-legal-landscape-of-cbd/) - In this CareTalk episode, host David Williams discusses the legal landscape of CBD with Michael C. Barnes, Counsel to Aimed Alliance. What should the federal role be? Why are states involved? And what does the 2018 Farm Bill have to do with it? Watch or listen to the 30-minute program on any of these platforms:
- [Aimed Alliance Releases Updated Gold Card Tool](https://aimedalliance.org/aimed-alliance-releases-updated-gold-card-tool/) - In 2022, Aimed Alliance released a new Gold Card tool summarizing all gold card legislation throughout the United States. The tool analyzed both successful and unsuccessful gold card legislation. Aimed Alliance is thrilled to share an updated version of this tool that includes 2023 legislation. The new resource is available here.
- [Aimed Alliance Releases New West Virginia Gold Card Resource for Providers](https://aimedalliance.org/aimed-alliance-releases-new-west-virginia-gold-card-resource-for-providers/) - In 2023, West Virginia amended it's Gold Card law to help reduce health care providers prior authorization administrative burdens. To ensure providers are aware of their rights and benefits under the recently amended law, Aimed Alliance has developed the below fact sheet containing important information regarding this new law. Read the new fact sheet here.
- [Emerging Trends: What Employers Need to Know About Alternative Funding Programs & Drug Carveouts](https://aimedalliance.org/emerging-trends-what-employers-need-to-know-about-alternative-funding-programs-drug-carveouts/) - On December 7, 2023, Aimed Alliance and the Alliance for Patient Access (AfPA) hosted a webinar on HR.com titled "Emerging Trends: What Employers Need to Know About Alternative Funding Programs & Drug Carveouts." View the webinar below.
- [Women Legislators Seek Regulation of Products Containing Hemp-Derived Cannabinoids](https://aimedalliance.org/women-legislators-seek-regulation-of-products-containing-hemp-derived-cannabinoids/) - FOR IMMEDIATE RELEASE Women Legislators Seek Regulation of Products Containing Hemp-Derived Cannabinoids Washington, DC — December 6, 2023 — The National Foundation for Women Legislators (NFWL) has passed a resolution calling for tighter regulation of consumer products containing hemp-derived cannabinoids. The resolution urges the U.S. Congress to provide the Food and Drug Administration (FDA) with
- [Cannabinoid Clarity: The Need for Federal Legislation](https://aimedalliance.org/cannabinoid-clarity-the-need-for-federal-legislation/) - On November 18, 2023, Aimed Alliance attorneys spoke at the annual conference of the National Foundation for Women Legislators (NFWL) in Orlando, Florida. Aimed Alliance’s presentation, titled “Cannabinoid Clarity: The Need for Federal Legislation to Protect Consumers, States, and Industry,” covered the shortcomings of current federal regulation of cannabinoid-containing consumer products. For example, consumers are
- [HHS Appeals Decision in 2021 NBPP Copay Accumulator Lawsuit](https://aimedalliance.org/hhs-appeals-decision-in-2021-nbpp-copay-accumulator-lawsuit/) - On September 29, 2023, the U.S. District Court for the District of Columbia issued a decision vacating the 2021 Notice of Benefit and Payment Parameters to the extent it permitted health plans to use a copay accumulator policy. On November 28, 2023, the Department of Health and Human Services ("HHS") filed a notice of appeal
- [FDA Announces Need for New Regulatory Pathway for CBD](https://aimedalliance.org/fda-announces-need-for-new-regulatory-pathway-for-cbd/) - On January 26, 2023, the Food and Drug Administration (Agency) announced that the existing regulatory frameworks are not appropriate for CBD products. Thus, the Agency called on Congress to develop a regulatory pathway that “balances individuals’ desire for access to CBD products with the regulatory oversight needed to manage risks.” In reaching its decision, the
- [UPCOMING WEBINAR: Emerging Trends: What Employers Need to Know About Alternative Funding Programs & Drug Carveouts](https://aimedalliance.org/upcoming-webinar-emerging-trends-what-employers-need-to-know-about-alternative-funding-programs-drug-carveouts/) - Many employees now consider health care benefits to be the single most important employee benefit. However, for employers, offering employees a comprehensive health benefits package can be costly, leading employers to consistently look for avenues to save on health care spending. Representatives from the Alliance for Patient Access (AfPA) and Aimed Alliance will share data from
- [Aimed Alliance Comments on GOP Healthcare Taskforce RFI](https://aimedalliance.org/aimed-alliance-comments-on-gop-healthcare-taskforce-rfi/) - On October, 15, 2023, Aimed Alliance submitted a comment to the House Budget Committee's Healthcare Taskforce request for information on regulatory, statutory, and implementation barriers that could be addressed to reduce health care spending; and recommendations to reduce improper payments in federal health care programs. Aimed Alliance's comment urged Congress to pass the Safe Step
- [New Report on Menopause in the Workplace: Addressing Employee Benefit Concerns](https://aimedalliance.org/new-report-on-menopause-in-the-workplace-addressing-employee-benefit-concerns/) - The recently published report, “Break Through the Stigma: Menopause in the Workplace,” unveiled significant findings concerning menopausal women in the workplace. Notably, the report found that 51 percent of peri- and post-menopausal women believe menopause has negatively affected their work life, while only 14 percent think their employers recognize the need for menopause-specific benefits. The
- [Uncovering Disparities in Medication Access: Copay Accumulator and Maximizer Policies](https://aimedalliance.org/uncovering-disparities-in-medication-access-copay-accumulator-and-maximizer-policies/) - A recent survey published in the Journal of Managed Care + Specialty Pharmacy has shed light on disparities in accessing essential medications. While the study revealed similar utilization rates of copay cards between non-white and white patients, it found a significant divergence in their exposure to copay accumulator and maximizer programs. More specifically, the research
- [Aimed Alliance publica un nuevo recurso que explica las implicaciones de la revocación de la NBPP de 2021](https://aimedalliance.org/aimed-alliance-publica-un-nuevo-recurso-que-explica-las-implicaciones-de-la-revocacion-de-la-nbpp-de-2021/) - A la luz de la reciente decisión del HIV + Hepatitis Policy Institute, et al. v. Health and Human Services (HHS), los pacientes y las organizaciones de defensa han buscado claridad sobre las implicaciones de la decision. Por lo tanto, Aimed Alliance ha creado un nuevo recurso de preguntas y respuests que explica neustra interpretacion
- [Aimed Alliance & NORM Release Updated Open Enrollment Brochures](https://aimedalliance.org/aimed-alliance-norm-release-updated-open-enrollment-brochures/) - The 2024 Open Enrollment period is fast approaching! The 2024 Open Enrollment period for Medicare Advantage plans is October 15, 2023, to December 7, 2023, while the Open Enrollment period of individuals, small group and large group plans on November 1, 2023, to December 15, 2023. To ensure consumers are able to select the health
- [Aimed Alliance Comments on IRA Patient Listening Sessions](https://aimedalliance.org/aimed-alliance-comments-on-ira-patient-listening-sessions/) - Recently, Aimed Alliance submitted a comment to the Centers for Medicaid and Medicare Services (CMS) on the Patient Listening Sessions related to the IRA Medicare drug price negotiations. Aimed Alliance's comment urged CMS to genuinely value patient's perspectives, and lived experiences as it related to the 10 selected prescriptions drugs. Aimed Alliance also urged CMS
- [Aimed Alliance Release New Resource Explaining Implications of the 2021 NBPP Revocation](https://aimedalliance.org/aimed-alliance-release-new-resource-explaining-implications-of-the-2021-nbpp-revocation/) - In light of the recent decision in the HIV + Hepatitis Policy Institute, et al. v. Health and Human Services (HHS), patients and advocacy organizations have sought clarity on the implications of the decision. Therefore, Aimed Alliance has created a new Q&A resource explaining our interpretation of the applicability of the decision. View the resource here.
- [US District Court Revokes 2021 NBPP Rule on Copay Accumulators](https://aimedalliance.org/us-district-court-revokes-2021-nbpp-rule-on-copay-accumulators/) - On September 29, 2023, the United States District Court for the District of Columbia held that the 2021 NBPP, which permitted the use of copay accumulators, would be set aside because it was arbitrary and capricious. In reaching this decision, the Court accepted the amicus brief filed by Aimed Alliance and fellow health policy and
- [House to Vote on Bill to Expand the ACA But It Also Includes Drug Price Controls](https://aimedalliance.org/house-to-vote-on-bill-to-expand-the-aca-but-it-also-includes-drug-price-controls/) - Today, the House is set to vote on H.R. 1425, “Patient Protection and Affordable Care Enhancement Act.” The bill contains several provisions to strengthen the Patient Protection and Affordable Care Act (ACA) and expand Medicaid. However, to pay for some of these changes, the bill also proposes to set drug price controls. The bill would
- [New Report from the National Association of Insurance Commissioners Calls Attention to Low-Value Short-Term Plans](https://aimedalliance.org/new-report-from-the-national-association-of-insurance-commissioners-calls-attention-to-low-value-short-term-plans/) - On July 22, 2019, the National Association of Insurance Commissioners (NAIC) released a report titled “2018 Market Share Reports for the Top 125 Accident and Health Insurance Groups and Companies by State and Countrywide.” Analyzing cost and market share trends among health plans, the report revealed that several short-term plans provide very little value in
- [Aimed Alliance Staff Attorney Discusses Recent Policy Activity Impacting Patients with Cancer](https://aimedalliance.org/aimed-alliance-staff-attorney-discusses-recent-policy-activity-impacting-patients-with-cancer/) - On May 24, 2019, Aimed Alliance Staff Attorney John A. Wylam joined Patient Power founder Andrew Schorr to discuss recent developments that could impact patients with cancer. This episode of Ask Aimed Alliance touched on state and federal legislative activity regarding step therapy, prior authorization, and copay accumulators, as well as providing updates on significant
- [Senators Call for HHS Secretary Becerra to Regulate Short-Term “Junk” Plans](https://aimedalliance.org/senators-call-for-hhs-secretary-becerra-to-regulate-short-term-junk-plans/) - A group of senators has called on U.S. Department of Health and Human Services Secretary Becerra to regulate short-term “junk” plans in light of the recent expansion of coverage options under the American Rescue Plan. “Junk” plans are short-term, limited duration insurance plans that are not required to provide coverage consistent with the Patient Protection
- [Congress Releases Highly Anticipated Drug Pricing Legislation](https://aimedalliance.org/congress-releases-highly-anticipated-drug-pricing-legislation/) - On May 23, 2019, the House Ways and Means Committee released draft legislation that would restructure how Medicare Part D pays for medications once beneficiaries enter the catastrophic coverage phase. Currently, the government pays 80 percent of a medication’s cost during the catastrophic coverage phase while the insurer pays 15 percent and the beneficiary pays
- [Do Formulary Lists Reduce Patient Access to Prescription Drugs?](https://aimedalliance.org/do-formulary-lists-reduce-patient-access-to-prescription-drugs/) - Laurie Toich, Associate Editor Formulary lists are used by pharmacy benefit managers (PBMs) to control costs and prevent unnecessary drug spending by incentivizing the use of lower cost and generic medications over costlier branded products. PBMs say this practice reduces overall spending on prescription drugs and helps patients lower their out-of-pocket costs; however, advocates argue
- [Complex Problems, Complex Solutions](https://aimedalliance.org/complex-problems-complex-solutions/) - On December 15, 2018, Aimed Alliance counsel Stacey L. Worthy joined staff from the Gabrail Cancer Center on The Cancer Gene podcast hosted on iHeart Radio. During this episode, the group discussed the growing use of nonmedical switching in the hospital setting, as well as the role of pharmacy benefit managers, pharmaceutical rebates, health care
- [Aimed Alliance Emphasizes the Need for Congressional Action to Reduce the Cost of Health Care in the U.S.](https://aimedalliance.org/aimed-alliance-emphasizes-the-need-for-congressional-action-to-reduce-the-cost-of-health-care-in-the-u-s/) - Last year, the Senate Health, Education, Labor & Pensions (HELP) Committee launched a process to draft legislation that would reduce the cost of health care in the United States, which began with the Committee soliciting feedback from interested health care stakeholders. In March 2019, Aimed Alliance provided initial recommendations to the Committee that touched on
- [Medicare Patients Sue HHS to Recover Costs for Observation Care](https://aimedalliance.org/medicare-patients-sue-hhs-to-recover-costs-for-observation-care/) - On August 19, 2019, a trial over a controversial Medicare policy will begin in federal court in Hartford, CT. The class action lawsuit was filed in 2011 by seven Medicare patients and their families, later joined by seven more plaintiffs, against the Department of Health and Human Services (HHS). The policy covers “observation care,” which
- [Rising Cost of Living Takes Priority Over Health Care for Most Americans](https://aimedalliance.org/rising-cost-of-living-takes-priority-over-health-care-for-most-americans/) - A report published this year by Enterprise Community Partners finds that housing costs and health care costs are frequently interconnected for Americans, with over half of the 1,000 renters surveyed having delayed medical care in order to pay rent. According to the report, all 500 medical professionals surveyed said that several patients have expressed concerns
- [Healthy Equity in IBD Report Underscores Need For Community-Centered Solutions to Inequity](https://aimedalliance.org/healthy-equity-in-ibd-report-underscores-need-for-community-centered-solutions-to-inequity/) - In 2022, Aimed Alliance recognized that health disparities exist in the inflammatory bowel disease (“IBD”) patient population. With rates of IBD continuing to increase over the last several years, there is a need to identify the root causes of outcome disparities for patients with IBD and develop solutions to redress these causes. To identify sources
- [New Data Calls Attention to the Dangers of the Online CBD Market and Consumer Confusion](https://aimedalliance.org/new-data-calls-attention-to-the-dangers-of-the-online-cbd-market-and-consumer-confusion/) - On October 21, 2019, LegitScript published findings from a study that was designed to assess the state of the online CBD market. This study looked at the state of regulatory compliance among vendors, the safety and accuracy of products, and issues regarding payment processing. The study surveyed online vendors to determine the rate of compliance
- [Congressional Cannabis Hearing Highlights a Need for Cautious Reform](https://aimedalliance.org/congressional-cannabis-hearing-highlights-a-need-for-cautious-reform/) - On January 15, 2020, the House Energy and Commerce Health Subcommittee held a hearing on cannabis titled “Cannabis Policies for the New Decade.” This hearing featured witnesses from the National Institutes of Health’s National Institute on Drug Abuse, the U.S. Food and Drug Administration (FDA), and the U.S. Drug Enforcement Agency (DEA). The hearing featured
- [DC Health Link Adopts Recommendations to Reduce Health Disparities](https://aimedalliance.org/dc-health-link-adopts-recommendations-to-reduce-health-disparities/) - In Fall 2020, the DC Health Benefit Exchange Authority’s Executive Board established a Social Justice and Health Disparities Working Group to “examine practices, structures, and policies that can be implemented to (1) expand access to providers and health systems for communities of color in the district; (2) eliminate health outcome disparities for communities of color
- [Step Therapy Reform: Strengthening Enforcement and Patient Protections to Deter Step Therapy Violations](https://aimedalliance.org/step-therapy-reform-strengthening-enforcement-and-patient-protections-to-deter-step-therapy-violations/) - In 2022, Senator Breslin introduced S8191, and Assemblyman McDonald introduced A9267 to create additional step-therapy patient protections, such as prohibiting patients from step through off-label medications, requiring patients to try and fail on more than one drug, or requiring step therapy for longer than 30 days. Read the fact sheet here.
- [Step Therapy Reform: Increased Reporting and Transparency](https://aimedalliance.org/step-therapy-reform-increased-reporting-and-transparency/) - In 2022, Senator Breslin introduced S8194 and S8798 and Assemblyman McDonald introduced A9265 and A9206 and Requiring insurers and utilization review agents to report and make certain information on step therapy publicly available, such as the number of requests, approvals, and reversals, the results of external reviews and appeals, and the types of specialties impacted,
- [Step Therapy Reform: Categorical Exceptions ](https://aimedalliance.org/step-therapy-reform-categorical-exceptions/) - In 2022, Senator Breslin introduced S8193 and Assemblyman McDonald introduced A9250 which would prohibit the use of step therapy policies in dermatology, gastroenterology, hematology, neurology, rheumatology, oncology, and ophthalmology. Prohibiting step-therapy for these therapeutic categories will help prevent serious disease progression and encourage optimal health outcomes in patients that might otherwise be limited by step-therapy policies. Read
- [New York Legislature Passes Legislation with Important Patient Protections During the 2022 Session ](https://aimedalliance.org/new-york-legislature-passes-legislation-with-important-patient-protections-during-the-2022-session/) - Press Release - July 6, 2022 (Albany, New York) – Over thirty patient advocacy and health policy organizations applaud the New York Legislature for passing multiple bills that expand protections for patients with health insurance in New York. Governor Hochul should swiftly sign these bills and ensure patients gain these important protections. During the 2022
- [Aimed Alliance Leads Sign-on Letter Calling on States to Improve Access to Care in Response to COVID-19 Outbreak](https://aimedalliance.org/aimed-alliance-leads-sign-on-letter-calling-on-states-to-improve-access-to-care-in-response-to-covid-19-outbreak/) - On March 31, 2020, Aimed Alliance led an effort to encourage state governors and Medicaid directors to rapidly respond to the public health challenges presented by Coronavirus Disease 2019 (COVID-19). Joined by 21 organizations, Aimed Alliance asked each state governor to improve health insurance coverage for treatments of underlying conditions that place individuals at high
- [New York Step Therapy Alliance Sends Letter Raising Concerns Over NYRx’s Step-Therapy Policy](https://aimedalliance.org/new-york-step-therapy-alliance-sends-letter-raising-concerns-over-nyrxs-step-therapy-policy/) - On September 22, 2023, the New York Step Therapy Alliance sent a letter to the New York Department of Health to raise concerns about the potential negative effects of the recently introduced step therapy protocols under the New York Medicaid Prescription Drug Program. The letter emphasized the detrimental aspects of step therapy policies, explaining that
- [Aimed Alliance Counsel Discusses Cannabinoids, Opioids at Nurses Conference](https://aimedalliance.org/aimed-alliance-counsel-discusses-cannabinoids-opioids-at-nurses-conference/) - On September 22, 2023, Michael C. Barnes, Counsel to Aimed Alliance, participated in a panel discussion on health policy at the 33rd Annual Conference of the American Society for Pain Management Nursing (ASPMN). Barnes joined ASPMN Past President Marsha Stanton, Ph.D., R.N.; and ASPMN Director of Government Affairs Wade Delk for the hour-long plenary session
- [MDPC sends letter to MA Legislature on Use of QALYs](https://aimedalliance.org/mdpc-sends-letter-to-ma-legislature-on-use-of-qalys/) - On September 19, 2023, the Movement Disorders Policy Coalition (MDPC) sent a letter to Chairwoman Friedman and Chairman Lawn of the Massachusetts Joint Committee on Health Care Financing supporting the elimination of quality-adjusted life year (QALY) in state regulated health plans. The quality-adjusted life year (QALY) is a valuation metric that is used by health
- [New Report Highlights Value of Treatments to Patients](https://aimedalliance.org/new-report-highlights-value-of-treatments-to-patients/) - A recent report by the Alliance for Patient Access (AfPA) titled "At What Price? Medication Value, Patient Care & the Inflation Reduction Act" highlights the differences between how the federal government defines medication value and how physicians do. The report discusses a recent survey by Germany's Federal Joint Committee that focused on how U.S. physicians
- [GOA Finds Rebates Do Not Lower Consumer Costs](https://aimedalliance.org/goa-finds-rebates-do-not-lower-consumer-costs/) - A recent report by the Government Accountability Office found that despite the substantial rebates private plans received for Medicare Part D medications from drug manufacturers, these rebates did not lower consumer costs. The GAO also found that payments by beneficiaries were often more than the plan sponsor's payment after accounting for rebates. Read the report
- [Aimed Alliance Comments on CMS's 340B Proposed Rule](https://aimedalliance.org/aimed-alliance-comments-on-cmss-340b-proposed-rule/) - On September 11, 2023, Aimed Alliance sent a letter to Centers for Medicare and Medicaid Services (CMS) commenting on CMS’s proposed rule addressing the 340B-Acquired Drug Payment Policy for Calendar Years 2018-2022 (CMS-1793-P). In response to the Supreme Court’s decision in American Hospital Association v. Becerra, which invalidated the reduction in prescription drug payment rates
- [Aimed Alliance Submits Comment on PA Benchmark Plan](https://aimedalliance.org/aimed-alliance-sends-comment-to-pa-insurance-commission-on-ehbs/) - On September 1, 2023, Aimed Alliance submitted a comment to Pennsylvania Insurance Commissioner request for information on the PA Benchmark Plan. Aimed Alliance's comment requested the benchmark plan ensure that specialty drugs are considered part of the essential health benefit for prescription drugs. Additionally, we requested the Insurance Commissioner ensure that the ACA exception process
- [New Survey for Employer Sponsored Health Plans](https://aimedalliance.org/new-survey-for-employer-sponsored-health-plans/) - Aimed Alliance and the Alliance for Patient Access are conducting a survey with HR.com to better understand how employers view alternative funding programs. What are alternative funding programs? Some employers partner with third-party companies to manage their specialty medications. Typically, these programs carve out all or a majority of specialty drugs from the plan's coverage
- [Aimed Alliance August Newsletter Available Now](https://aimedalliance.org/aimed-alliance-august-newsletter-available-now/) - On August 31, 2023, Aimed Alliance released its August 2023 Newsletter. This issue of Aimed Monthly includes includes an op-ed, two new CBD resources, new Know Your Rights brochures for Growth Hormone Deficiency, two letters on step therapy, and much more. Read the August Newsletter here. All Aimed Alliance newsletters are available here.
- [HHS Announces 10 Drugs Subject to Medicare Price Negotiations](https://aimedalliance.org/hhs-announces-10-drugs-subject-to-medicare-price-negotiations/) - On August 29, 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), selected the first set of 10 Medicare Part D drugs for negotiation under the Inflation Reduction Act (IRA). During the negotiation process, various factors will be taken into account including the clinical advantages
- [Congress Requests Information on Regulation of CBD ](https://aimedalliance.org/congress-requests-information-on-regulation-of-cbd-2/) - On July 27, 2023, a bipartisan group of lawmakers issued a Request for Information (RFI) regarding the regulation of hemp-derived CBD products. The RFI seeks to evaluate the possibility of establishing a comprehensive regulatory framework for CBD. Congress seeks insights on CBD market dynamics, regulatory pathways, product scope, safety concerns, risk-benefit profiles, quality controls, and
- [New Resources Support Individuals with Growth Hormone Deficiency](https://aimedalliance.org/new-resources-support-individuals-with-growth-hormone-deficiency/) - English and Spanish materials include information on growth hormone deficiency symptoms, diagnosis, treatment, and health insurance appeals. WASHINGTON, DC / ACCESSWIRE / August 28, 2023 / The not-for-profit Aimed Alliance has produced and published new resources to help consumers with growth hormone deficiency navigate the diagnosis, treatment, and health insurance coverage and appeals processes. The new
- [Groups File Amicus Brief to Shed Light on Harmful Drug Sourcing Tactics](https://aimedalliance.org/groups-file-amicus-brief-to-shed-light-on-harmful-drug-sourcing-tactics/) - 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
- [SAMHSA's Fact Sheet Underscores the Potential Risks of CBD](https://aimedalliance.org/samhsas-fact-sheet-underscores-the-potential-risks-of-cbd/) - The rising popularity of cannabidiol (CBD) has ignited conversations about its potential benefits, but SAMHSA's advisory fact sheet sheds light on crucial considerations. Non-FDA-approved CBD products have garnered significant attention due to their marketing for various health conditions and polls indicate a substantial increase in CBD product usage among Americans. The fact sheet raises concerns
- [Advocacy Organizations Send Letter to Payer Matrix Regarding Its Identification as a "Patient Advocacy" Company](https://aimedalliance.org/advocacy-organizations-send-letter-to-payer-matrix-regarding-its-identification-as-a-patient-advocacy-company/) - On August 17, 2023, thirty-four organizations sent a letter to Payer Matrix urging it to stop self-identifying as a "patient advocacy company" and a "leading patient advocate". The letter recognized that patient advocacy organizations aim to advocate on behalf of their community to ensure their voices, concerns, and stories, are heard and responded to by
- [Aimed Alliance's New Resources on CBD Regulation and Labeling](https://aimedalliance.org/aimed-alliances-new-resources-on-cbd-regulation-and-labeling/) - On Aug. 16, Aimed Alliance published two new resources addressing critical aspects of cannabidiol (CBD) regulation. The Food and Drug Administration (FDA) has determined that current safety standards for foods and dietary supplements cannot be met by consumer products containing CBD. To address this, the FDA urged Congress to establish a dedicated regulatory framework tailored
- [CONOZCA SUS DERECHOS: Deficiencia de la hormona del crecimiento](https://aimedalliance.org/conozca-sus-derechos-deficiencia-de-la-hormona-del-crecimiento/) - Nueva alerta de recursos -- CONOZCA SUS DERECHOS: Deficiencia de la hormona del crecimiento La deficiencia de la hormona del crecimiento (GHD) en los niños se define como una falla en el crecimiento asociada con una producción inadecuada de la hormona del crecimiento (GH). La GH es producida por la glándula pituitaria del cerebro y
- [Aimed Alliance Urges Medicare Advantage Plans to Stop Imposing Double-Step Fail-First Policies](https://aimedalliance.org/aimed-alliance-urges-medicare-advantage-plans-to-stop-imposing-double-step-fail-first-policies/) - On August 9, 2023, Aimed Alliance sent letters to Aetna and UnitedHealthcare urging them to reconsider their use of double-step fail-first policies in Medicare Advantage plans. Step-therapy policies, often known as “fail first,” require patients to try and fail on alternative treatments, sometimes causing adverse effects, before the plan will cover the originally prescribed treatment.
- [Aimed Alliance Release New Resource on Growth Hormone Overproduction](https://aimedalliance.org/aimed-alliance-release-new-resource-on-overproduction-of-growth-hormone/) - While many individuals will not have problems with their body’s production of growth hormone, some individuals can develop either an underproduction of growth hormone or an overproduction of growth hormone. When an individual’s body overproduces growth hormone, they may have a condition known as “acromegaly” or “gigantism.” In some cases, overproduction of GH can be
- [New Resource Alert -- KNOW YOUR RIGHTS: Growth Hormone Deficiency](https://aimedalliance.org/new-resource-alert-know-your-rights-growth-hormone-deficiency/) - Growth hormone deficiency (GHD) in children is defined as growth failure associated with inadequate growth hormone (GH) production. GH is produced by the brain's pituitary gland and is essential for muscle and bone growth, strength, and distribution of body fat. Individuals with GHD need GH treatments to replace their bodies lack of GH production. However,
- [Aimed Alliance Releases Easy-Read Know Your Rights](https://aimedalliance.org/aimed-alliance-releases-easy-read-know-your-rights-resource/) - On Aug. 11, 2023, Aimed Alliance released a new Easy-Read Know Your Rights brochure for patients with Movement Disorders. An "Easy Read" resource combines text with layout and imagery to simplify and explain information. Easy Read is a way to present information for people who are not familiar with English, or who have low literacy
- [Congress Introduces Gold Card Act of 2023](https://aimedalliance.org/congress-introduces-gold-card-act-of-2023/) - On August 2, 2023, Congressman Gonzalez (TX-34) and Congressman Burgess (TX-26) introduced the GOLD CARD ACT of 2023 (H.R. 4968). The Gold Card Act of 2023 would exempt qualifying physicians from prior authorization requirements for patients with Medicare Advantage plans. “Prior authorization requirements often delay or deter patient access to necessary care,” said Christopher S.
- [Congress Requests Information on Regulation of CBD](https://aimedalliance.org/congress-requests-information-on-regulation-of-cbd/) - On July 27, 2023, a bipartisan group of lawmakers issued a Request for Information (RFI) regarding the regulation of hemp-derived CBD products. The RFI seeks to evaluate the possibility of establishing a comprehensive regulatory framework for CBD. Congress seeks insights on CBD market dynamics, regulatory pathways, product scope, safety concerns, risk-benefit profiles, quality controls, and
- [FTC States Its' Previous Findings on PBMs May No Longer Be Accurate](https://aimedalliance.org/ftc-states-its-previous-findings-on-pbms-may-no-longer-be-accurate/) - On July 20, 2023, the Federal Trade Commission (FTC) issued a statement cautioning any reliance on nine FTC advocacy letters released between 2004 and 2014. The FTC voted to issue this statement as the previous letters may no longer reflect the current PBM industry. In response to the FTC issuing this statement, the Pharmaceutical Care
- [CMS Audit Raises Concerns Regarding MA Plan Compliance](https://aimedalliance.org/cms-audit-raises-concerns-regarding-ma-plan-compliance/) - The Centers for Medicare and Medicaid Services most recent Medicare Advantage (MA) audit, which covered approximately 30 percent of MA Part C and Part D contracts, found significant problems with plan compliance and formulary administration. Specifically, the audit found that “[s]ponsors applied utilization management edits that were not part of their CMS-approved formulary.” The audit
- [White House Creates Permanent Pandemic Preparedness Office](https://aimedalliance.org/white-house-creates-permanent-pandemic-preparedness-office/) - On July 21, the Biden administration announced that the White House would be creating a permanent pandemic preparedness office as part of the Executive Office of the President. This new office will oversee the government's response to COVID-19, monkeypox, polio, respiratory syncytial virus (RSV), and influenza. This office will also oversee efforts to develop, manufacturer,
- [Patient advocates claim partial victory in New York — but there’s more work to do](https://aimedalliance.org/patient-advocates-claim-partial-victory-in-new-york-but-theres-more-work-to-do/) - © Ashira Vantrees – USA TODAY NETWORK (OPINION: This piece expresses the views of its author(s), separate from those of USA TODAY). Used with permission. Link to original article can be found here: https://www.democratandchronicle.com/story/opinion/2023/07/19/ny-patient-transparency-wins-are-great-but-theres-more-work-to-do/70424128007/ Over the past several years, Aimed Alliance has worked with patient advocacy groups and lawmakers to help improve outcomes for health care consumers, but some
- [NAIC Presses Congress, Treasury to Ensure States Can Regulate Plan Cost-Sharing](https://aimedalliance.org/naic-presses-congress-treasury-to-ensure-states-can-regulate-plan-cost-sharing/) - The National Association of Insurance Commissioners (NAIC) recently sent letters to the US Senate and the Department of Treasury requesting clarification on the current cost-sharing rules that apply to health savings accounts (HSAs) with high-deductible health plans (HDHPs). Specifically, the NAIC asked the Treasury Department for clarification on regulations that prevent state copay accumulator ban
- [Advocates Urge Governor Hochul to Pass Patient Notification Bill](https://aimedalliance.org/advocates-urge-governor-hochul-to-pass-patient-notification-bill/) - On July 10, 2023 the New York Step Therapy Alliance sent a letter to Governor Hochul urging her to sign into law S.2677/A.463. Sponsored by Senator Neil Breslin and Assemblymember John McDonald. This bill would require health insurance plans to include certain information in a step-therapy denial letter. Step-therapy policies require patients to try and
- [Aimed Alliance Comments on Medicaid Drug Rebate Program](https://aimedalliance.org/aimed-alliance-comments-on-medicaid-drug-rebate-program/) - On July 25, 2023, Aimed Alliance submitted a comment to the Centers for Medicare and Medicaid Services (CMS) on it proposed rule relating to the Medicaid Drug Rebate Program. Aimed Alliance supported CMS’s decision to exclude copay assistance from the Best Price Rule, while also opposing CMS’s proposal to mandate a consumer’s diagnosis be included
- [Price Transparency Cases](https://aimedalliance.org/price-transparency-cases/) - Merck & Co., Inc., et al. v. U.S. Department of Health and Human Services Brief Summary: A group of pharmaceutical manufacturers sued the U.S. Department of Health and Human Services (HHS), challenging the agency’s rule that requires pharmaceutical manufacturers to disclose their list prices in direct-to-consumer advertisements. Overview: On June 14, 2019, a group of
- [Pharmacy Benefit Manager Cases](https://aimedalliance.org/pharmacy-benefit-managers/) - Rutledge v. Pharmaceutical Care Management Association Brief Summary: On August 13, 2015, the Pharmaceutical Care Management Association (PCMA), a trade association representing Pharmacy Benefit Managers (PBMs), filed suit against Attorney General Leslie Rutledge of Arkansas. The suit alleged that a state statute regulating PBMs is preempted by the Employee Retirement Income Security Act (ERISA), Medicare
- [Franciscan Alliance v. Azar](https://aimedalliance.org/franciscan-alliance-v-azar/) - Brief Summary: This case challenges Section 1557 of the Patient Protection and Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, age, disability, and sex. Here, the plaintiffs challenged whether sex-based discrimination includes discrimination based on gender identity and termination of pregnancy. Overview: Section 1557 of the ACA prohibits
- [New Resources Support Individuals with Rare Endocrine Disorders](https://aimedalliance.org/new-resources-support-individuals-with-rare-endocrine-disorders/) - English and Spanish materials include information on rare endocrine disorders, symptoms, diagnosis, treatment, and health insurance appeals. WASHINGTON, DC / ACCESSWIRE / July 19, 2023 / The not-for-profit Aimed Alliance has produced and published new resources to help consumers with rare endocrine disorders navigate the diagnosis, treatment, and health insurance coverage and appeals processes. The new publication titled Rare
- [Primary Care Providers Reluctant to Talk About CBD](https://aimedalliance.org/primary-care-providers-reluctant-to-talk-about-cbd/) - Most primary care providers (PCPs) are hesitant to recommend cannabidiol (CBD) products to patients given doubts regarding the products’ safety and effectiveness. In a survey of 235 PCPs, doctors stated that CBD was often brought up by patients during medical appointments, but most PCPs do not feel as though they are knowledgeable about the products
- [Aimed Alliance Releases Know Your Rights for Patients with Movement Disorders](https://aimedalliance.org/aimed-alliance-release-know-your-rights-for-patients-with-movement-disorders/) - On June 30, Aimed Alliance released a new Know Your Rights brochure for patients with Movement Disorders. A movement disorder Movement disorders are a group of neurologic conditions characterized by altered coordination of movements, including increased, slow, or reduced movements. This new brochure provides an overview of movement disorder diagnosis and treatments. In addition, the
- [Overpayments to Medicare Advantage Could Exceed $25 Billion](https://aimedalliance.org/overpayments-to-medicare-advantage-could-exceed-25-billion/) - A recent study by the University of Southern California found that in 2023, Medicare Advantage plans may have been overpaid by nearly 6 percent, an estimated $27 billion. With Medicare Advantage enrollment increasing in recent years, this analysis highlights the urgent need for Congress to reassess Medicare Advantage reimbursement. Medicare Advantage reimbursement can be particularly
- [Medicaid Coverage of COVID-19 and RSV Vaccines](https://aimedalliance.org/medicaid-coverage-of-covid-19-and-rsv-vaccines/) - Under the Inflation Reduction Act (IRA), Medicaid is still required to cover approved COVID-19 vaccines and all other CDC Advisory Committee on Immunization (ACIP) recommended vaccines with no-cost sharing to consumers. However, this requirement does not extend to COVID-19 vaccines that were approved under an emergency use authorization (EUA). In addition, CMS has clarified that
- [Aimed Alliance to Participate in Chronic Disease Month Event](https://aimedalliance.org/aimed-alliance-to-participate-in-chronic-disease-panel-event/) - Aimed Alliance is thrilled to be participating in the Chronic Disease Coalition's 2023 Chronic Disease Month Symposium on July 10, 2023! Aimed Alliance Counsel, Ashira Vantrees, will be participating in the "Managing the High Cost of Chronic Disease" and discussing the importance of federal laws such as the Americans with Disabilities Act (ADA) and the Family
- [Aimed Alliance Calls on FTC to Combat Unfair Non-EHB and AFP Schemes](https://aimedalliance.org/aimed-alliance-calls-on-ftc-to-combat-unfair-non-ehb-and-afp-schemes/) - On June 14, 2023, Aimed Alliance sent a letter to the Federal Trade Commission (FTC) urging the Commissioner to take appropriate enforcement action against non-essential health benefit (non-EHB) and alternative funding programs. The letter provides a explanation of the reasons why the FTC holds the authority to regulate these unjust trade practices, and alleges that
- [Drug Distributor Vows to Fight DEA](https://aimedalliance.org/drug-distributor-vows-to-fight-dea/) - Morris & Dickson, the fourth-largest drug distributor in the U.S., vows to fight efforts by the DEA to deprive it of its registration to sell controlled substances and opioids to pharmacies, hospitals, and health systems. If carried out by the DEA, this registration revocation would put the drug distributor out of business and may aggravate
- [Connecticut Attorney General Shares Concerns on Unregulated Cannabis](https://aimedalliance.org/connecticut-attorney-general-shares-concerns-on-unregulated-cannabis/) - The office of the Attorney General recently announced a crackdown on unregulated THC products, like delta-8. Earlier this year, the Connecticut Attorney General filed lawsuits against five retailers, alleging that each was illegally selling delta-8 THC products that resembled “youth-oriented snacks and candies.” The Attorney General also sent these same retailers additional warning letters reminding
- [Denials of Health Insurance Claims Are Rising](https://aimedalliance.org/denials-of-health-insurance-claims-are-rising/) - Millions of Americans have run into the experience of filing a health insurance claim only to have it quickly denied. Utilizing computer algorithms or individuals with little relevant experience to issue mass denials of insurance claims has become increasingly popular among insurers. This is a way for insurers to keep profits high, yet is exactly
- [Patients Win Big During New York's 2023 Legislative Session](https://aimedalliance.org/patients-win-big-during-new-yorks-2023-legislative-session/) - The New York Assembly and Senate have officially adjourned until 2024, and Aimed Alliance is thrilled to share that several patient protection bills were passed during this 2023 Session! (1) Transparency & Patient Notification The New York Step Therapy Alliance, led by Aimed Alliance, advocated for the passage of S.2677/A.463, a bill that will require
- [DFS Clarifies NY Step Therapy Law Applies to Medical Necessity Policies](https://aimedalliance.org/dfs-clarifies-ny-step-therapy-law-applies-to-medical-necessity-policies/) - Select health plans have recently alleged that their step-therapy policies, that were titled "medical necessity policies", were not governed by the NY step therapy law based on a Q&A from the NY Department of Financial Services (DFS) 54(11.4%). Aimed Alliance disagreed with this interpretation and sought clarification from DFS regarding whether a medical necessity policy
- [Aimed Alliance to Join Employer Health Benefits Panel](https://aimedalliance.org/aimed-alliance-to-join-employer-health-benefits-panel/) - Aimed Alliance Counsel, Ashira Vantrees, will be participating in a upcoming panel for employers on "Pharmacy Fiasco: Key Topics & Opportunities for Employers." The panel discussion is part of the Mid-West Business Group on Health's annual meeting in Chicago, Illinois. Learn more about this upcoming event here.
- [Consumers Skip Medical Care Due to Unaffordability](https://aimedalliance.org/consumers-skip-medical-care-due-to-costs/) - A recent survey by the Federal Reserve found that in 2022, nearly 28 percent of adults in the United States went without medical care due to cost. This number increased from the reported 24 percent of adults who went without care in 2021. Survey respondents were most likely to skip dental care followed by specialty
- [Aimed Alliance Asks CT Insurance Commissioner to Address Non-EHB Programs](https://aimedalliance.org/aimed-alliance-asks-ct-insurance-commissioner-to-address-non-ehb-programs/) - On May 23, 2023, Aimed Alliance sent a letter to the Connecticut Insurance Commissioner requesting he take action to address how Connecticut union worker' health plans are using non-essential health benefit programs. Considering the Connecticut Insurance Commissioner has primary authority to implement and ensure compliance with the ACA, Aimed Alliance requested the Commissioner clarify that
- [DEA Concludes Delta-8 and Delta-9 THC-O are Controlled Substances](https://aimedalliance.org/dea-concludes-delta-8-and-delta-9-thc-o-are-controlled-substances/) - On February 13, 2023, the Drug Enforcement Administration (DEA) responded to an inquiry by a North Carolina attorney regarding the control status under the Controlled Substances Act (CSA) of THC acetate ester (THC-O). The DEA concluded that delta-9 THC-O and delta-8 THC-O fall under the CSA’s definition of tetrahydrocannabinols (THC), which are controlled under Schedule
- [Fifth Circuit Pauses Ruling That Threatened ACA Preventive Health Care](https://aimedalliance.org/fifth-circuit-pauses-ruling-that-threatened-aca-preventive-health-care/) - On May 15, the Fifth Circuit Court of Appeals agreed to temporarily stay the lower court's decision in Braidwood Management v. Becerra. The lower court's ruling overturned the Affordable Care Act’s preventative services mandate which currently requires health plans to cover certain preventative care services with no cost-sharing. The lower court's decision jeopardizes access to
- [Senate HELP Committee Votes to Advance PBM Reform Act](https://aimedalliance.org/senate-help-committee-votes-to-advance-pharmacy-benefit-manager-reform-act/) - The Senate Health, Education, Labor, and Pensions (HELP) Committee voted 18-3 to advance the Pharmacy Benefit Manager Reform Act of 2023 out of the Committee. The Pharmacy Benefit Manager Reform Act of 2023 would impose transparency measures on Pharmacy Benefit Manager (“PBMs”), ban spread pricing, and mandate that PBMs pass 100 percent of the rebates
- [Optum Publishes Article on Alternative Funding Programs](https://aimedalliance.org/optum-publishes-article-on-alternative-funding-programs/) - Optum, a pharmacy benefit manager (PBM), recently published an article on some of the risks associated with alternative funding programs. The article recognizes the growing adoption of alternative funding programs by employers, how these programs harm patients, and jeopardize the sustainability of patient assistance programs. Read the article here.
- [DEA and SAMHSA Extend COVID-19 Telemedicine Flexibilities](https://aimedalliance.org/dea-and-samhsa-extend-covid-19-telemedicine-flexibilities/) - On May 10, 2023, the U.S. Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary rule, extending some telemedicine flexibilities adopted under the COVID-19 Public Health Emergency (PHE). This rule becomes effective May 11, 2023. This temporary rule was published in response to two proposed rules by DEA
- [CMS Finalizes Medicare Advantage Marketing Reforms](https://aimedalliance.org/cms-finalizes-medicare-advantage-marketing-reforms/) - On April 5, 2023, the Centers for Medicare and Medicaid Services (CMS) issued a final rule revising the regulations governing the marketing of Medicare Advantage (MA) and Medicare Part D plans. The final rule targets deceptive marketing practices that have been a notable topic of concern for CMS. The final rule includes reforms such as
- [Aimed Alliance Quoted in Article on the Cost of Chronic Disease and Conversations with Health Care Providers](https://aimedalliance.org/aimed-alliance-quoted-in-article-on-the-cost-of-chronic-disease-and-conversations-with-health-care-providers/) - Aimed Alliance Counsel, Ashira Vantrees, was recently quoted in a Health Central article on how consumers with chronic conditions can manage their health care costs. The article also cites Aimed Alliance's “Let’s Talk: Questions and Conversations You Should Have with Your Health Care Provider” resource as a helpful tool for consumers. Read the article here.
- [Aimed Alliance Quoted in Health Central Article](https://aimedalliance.org/aimed-alliance-quoted-in-health-central-article/) - Aimed Alliance Counsel, Ashira Vantrees, was quoted in a recent Health Central article on the high health care costs experienced by individuals with chronic conditions. ““. . . when we talk about health care costs for individuals with chronic conditions, we need to remember that these individuals also deal with the same common, often inconvenient,
- [Aimed Alliance Releases New Fact Sheet on Step Therapy for Texans](https://aimedalliance.org/aimed-alliance-releases-texas-step-therapy-resources-for-patients-providers-and-advocates/) - In 2017, Texas passed a step-therapy law that placed guardrails on step-therapy policies to protect health care consumers. Step therapy, also known as fail-first, requires consumers to try and fail on alternative treatments before the plan will cover the originally prescribed treatment. To ensure providers are aware of their rights and benefits under this new
- [Aimed Alliance Releases New Resource on Step Therapy for West Virginia Patients, Providers, and Advocates](https://aimedalliance.org/aimed-alliance-releases-resource-on-step-therapy-resource-for-west-virginia-patients-providers-and-advocates/) - In 2017, West Virginia passed a step-therapy law that placed guardrails on step-therapy policies to protect health care consumers. Step therapy, also known as fail-first, requires consumers to try and fail on alternative treatments before the plan will cover the originally prescribed treatment. To ensure providers are aware of their rights and benefits under this
- [Aimed Alliance Urges North Dakota Legislative Assembly to Pass Copay Accumulator Reform](https://aimedalliance.org/aimed-alliance-urges-north-dakota-legislative-assembly-to-pass-copay-accumulator-reform/) - On April 13, 2023, Aimed Alliance sent a letter to the North Dakota Legislative Assembly urging the Assembly to swiftly pass copay accumulator reform. When patients cannot afford their medications, they may rely on financial assistance from pharmaceutical manufacturers and other third parties to meet their health plan’s cost-sharing responsibilities. The value of this third-party
- [FDA Commits to Taking Action Against Programs that Import or Offer to Import Illegal Prescription Drugs and Products](https://aimedalliance.org/fda-commits-to-taking-action-against-programs-that-import-or-offer-to-import-illegal-prescription-drugs-and-products/) - At the end of February 2023, Aimed Alliance sent a letter to the Food and Drug Administration (FDA) Office of Regulatory Affairs and Office of Importation Operations, arguing that alternative funding programs were illegally importing prescription drugs from outside the United States and jeopardizing the health and safety of consumers in the United States. Our
- [CMS Finalizes Prior Authorization Reform for Medicare Advantage Plans](https://aimedalliance.org/cms-finalizes-prior-authorization-reform-for-medicare-advantage-plans/) - On April 5, 2023, the U.S. Department of Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS), finalized its 2024 Medicare Advantage (MA) and Part D Rule. The final rule streamlines prior authorization requirements by requiring plans: (1) Uphold a prior authorization approval for as long as the treatment is
- [Available Now: Essential Health Benefits, Importation, and More -- Do You Know the Risks?](https://aimedalliance.org/available-online-now-cannabis-cbd-and-cannabinoids-what-employers-and-consumers/) - On December 13, Aimed Alliance hosted a webinar on HR.com title "Essential Health Benefits, Importation, and More -- Do You Know the Risks?" View the webinar below. https://youtu.be/U9-rJZ9YjLU
- [Aimed Alliance Newsletters](https://aimedalliance.org/newsletters/) - Subscribe to our newsletters. Review past newsletters below. 03/31/2023 -- Aimed Monthly, Volume 5, Issue 3 02/28/2023 -- Aimed Monthly, Volume 5, Issue 2 01/31/2022 - Aimed Monthly, Volume 5, Issue 1 12/30/2022 - Aimed Monthly, Volume 4, Issue 12 11/31/2022 - Aimed Monthly, Volume 4, Issue 11 10/31/2022 - Aimed Monthly, Volume 4, Issue
- [Pennsylvania Court Joins Several States in Requiring Employers to Reimburse Medical Cannabis](https://aimedalliance.org/pennsylvania-court-joins-several-states-in-requiring-employers-to-reimburse-medical-cannabis/) - On March 17, 2023, the Commonwealth Court of Pennsylvania held, in Fegley v. Firestone Tire & Rubber (Workers' Comp. Appeal Bd.), that workers’ compensation plans must cover cannabis-related expenses when an employee uses it to recover from a workplace-related injury. In reaching this decision the Court reasoned that under the Pennsylvania Workers’ Compensation Act, employees
- [Ohio Attorney General Files Lawsuit Against PBMs](https://aimedalliance.org/ohio-attorney-general-files-lawsuit-against-pbms/) - On March 27, 2023, the Ohio Attorney General filed a lawsuit against Express Scripts, Prime Therapeutics, and Humana Pharmacy Solutions, alleging that these Pharmacy Benefit Managers (PBMs) used a Switzerland-based company to increase the cost of prescription drugs and push these increased costs to health care consumers. The lawsuit also names Cigna Group (parent company
- [The White House and Federal Agencies Focus on Addressing Long COVID](https://aimedalliance.org/the-white-house-and-federal-agencies-focus-on-combatting-long-covid-symptoms/) - Some patients that have recovered from a COVID-19 infection experience what the CDC has termed “long-COVID”. Long-COVID is a condition which results in individuals experiencing long-term side effects from a COVID-19 infection. Long-COVID symptoms can persist for weeks to months after an infection and include symptoms of fatigue, fever, difficulty breathing, stomach pain, dizziness, and
- [Medicare Coverage of Telehealth Services in 2023](https://aimedalliance.org/medicare-coverage-of-telehealth-services-in-2023/) - On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a rule that outlines which telehealth services will be covered for an additional 151 days after the public health emergency (PHE) ends to allow for a transition period. The following policies and services will be available under the 151-day extension: (1) Telehealth
- [Minnesota Board of Pharmacy Files Civil Lawsuit against Northland Vapor](https://aimedalliance.org/minnesota-board-of-pharmacy-files-civil-lawsuit-against-northland-vapor/) - On December 5, 2022, the Minnesota Board of Pharmacy announced that it filed a civil lawsuit against three limited liability companies known collectively as “Northland Vapor.” The lawsuit alleges Northland Vapor violated Minnesota’s edible cannabinoid laws, which provide that an edible cannabinoid product sold in Minnesota cannot contain more than five milligrams of hemp-derived THC
- [Ninth Circuit Declares that Hemp-Derived Delta-8 THC Products are Legal Under Federal Law](https://aimedalliance.org/ninth-circuit-declares-that-hemp-derived-delta-8-thc-products-are-legal-under-federal-law/) - A panel of the U.S. Court of Appeals for the Ninth Circuit tentatively ruled on May 19, 2022, that hemp-derived delta-8 THC products are legal. This ruling follows a lawsuit in which AK Futures, an e-cigarette and vaping products manufacturer, claimed that Boyd Street Distro, a Los Angeles smoke products wholesaler, was committing copyright and
- [New Education Requirement for Prescribers of Controlled Substances](https://aimedalliance.org/new-education-requirement-for-prescribers-of-controlled-substances/) - The Medication Access and Training Expansion (MATE) Act was incorporated into the Consolidated Appropriations Act of 2023. This bill requires any practitioner, as a condition of receiving or renewing a registration to prescribe controlled substances, to complete a one-time, eight-hour training on the treatment of substance use disorders or the pharmacological management of pain. This
- [Expansion of the 14-Day Injectable MOUD Limit to 45 Days](https://aimedalliance.org/expansion-of-the-14-day-injectable-moud-limit-to-45-days/) - On December 29, 2022, President Biden signed the Consolidated Appropriations Act of 2023. Section 1264 amended Section 309A(a)(5) of the Controlled Substances Act. Section 309A(a)(5) provided that controlled substances could only be administered to a patient within 14 days of the pharmacy delivering the medication to a practitioner. The amendment changes the number of days
- [UPCOMING WEBINAR MARCH 29: Change Is Law - A Federal Drug Policy Update](https://aimedalliance.org/upcoming-webinar-march-29-change-is-law-a-federal-drug-policy-update/) - The federal government’s COVID-19 public health emergency (PHE) declaration will end on May 11, 2023. The drug poisoning PHE, first declared in 2017, is certain to be extended, as more than 100,500 fatal drug poisonings occurred in the U.S. in the 12 months ending in September 2022. In this free, one-hour webinar, two drug policy
- [Digital Therapeutics: What They Are and How to Integrate Them in Addiction Treatment Workflows](https://aimedalliance.org/digital-therapeutics-what-they-are-and-how-to-integrate-them-in-addiction-treatment-workflows/) - This session will focus on the emerging role of digital therapeutics (DTx) in the treatment of substance use disorders (SUDs), including co-implementation alongside telehealth solutions, to help address the barriers to effective delivery of neurobehavioral care. Despite SUD being a chronic disease requiring longitudinal physical and mental recovery services, more than 90% of patients do
- [Alternative Funding Programs: The Cost Saving Program That Could Cost You](https://aimedalliance.org/alternative-funding-programs-the-cost-saving-program-that-could-cost-you/) - On March 20, 2023, Aimed Alliance released a new fact sheet titled "Alternative Funding Programs: The Cost Sharing Program That Could Cost You". This new fact sheet explains how health plans are partnering with third-party specialty medication programs to define medications as non-essential health benefits and source treatments from (1) manufacturer copay assistance programs; (2)
- [Senate Finance Committee Republicans Urge Senior Government Officials Against Use of Discriminatory Metrics in Federal Health Programs](https://aimedalliance.org/senate-finance-committee-republicans-urge-senior-government-officials-against-use-of-discriminatory-metrics-in-federal-health-programs/) - On March 1, 2023, Senator Mike Crapo (R-ID), along with other Senate Finance Committee Republicans, sent a letter to Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS), and Chiquita Brooks-LaSure, Administrator of the Centers for Medicare & Medicaid Services (CMS), urging the agencies to end the use of quality-adjusted life
- [DEA Announces Proposed Rules Limiting Permanent Telemedicine Flexibilities](https://aimedalliance.org/dea-announces-proposed-rules-limiting-permanent-telemedicine-flexibilities/) - On February 24, 2023, the DEA released its proposed rules for prescribing controlled medications via telemedicine after the COVID-19 public health emergency (PHE) ends. The rule would reimpose some restrictions and would prohibit prescribing of Schedule II controlled drugs or narcotics via telehealth. The rule would allow telehealth prescribing of a thirty-day supply of schedule
- [New Know Your Rights Brochure for Individuals with Rare Endocrine Disorder](https://aimedalliance.org/new-know-your-rights-brochure-for-individuals-with-rare-endocrine-disorder/) - On February 27, Aimed Alliance released a new Know Your Rights brochure for patients with Rare Endocrine Disorders. An endocrine disorder is a condition that affects the endocrine system, which is a network of glands that produce and release various hormones. Hormones regulate many important bodily functions, including metabolism (digestion, blood circulation, body temperature), sexual
- [Let's Talk: Questions & Conversations You Should Have with Your Health Care Provider](https://aimedalliance.org/lets-talk-questions-conversations-you-should-have-with-your-health-care-provider/) - For many individuals it can feel overwhelming being diagnosed with a new rare or chronic condition. This can be especially true for individuals who, otherwise have had a limited interaction with the health care system. Therefore, to help ensure consumer have the necessary tools to be active participants throughout their health care journey, Aimed Alliance has
- [Aimed Alliance Releases New Fact Sheet on New York Step Therapy Reform](https://aimedalliance.org/aimed-alliance-releases-new-fact-sheet-on-new-york-step-therapy-reform/) - Step therapy polices, also known as “fail first,” are a practice used by insurers and pharmacy benefit managers (PBMs) to require consumers to try and fail on alternative treatments, before the insurer or PBM will cover the originally prescribed treatment. In 2016, New York passed a step therapy law, which places certain guardrails on step
- [Aimed Alliance and 28 Other Advocacy Organizations Submit Amicus Brief In Copay Accumulator Lawsuit](https://aimedalliance.org/aimed-alliance-and-28-other-advocacy-organizations-submit-amicus-brief-in-copay-accumulator-lawsuit/) - Aimed Alliance, and twenty-eight other organizations asked the U.S. District Court for the District of Columbia to accept their amicus curiae brief in the HIV + Hepatitis Policy Institute, Diabetes Patient Advocacy Coalition & Diabetes Leadership Council v. Department of Health and Human Services lawsuit. Civil litigation involves a dispute between a plaintiff and a defendant,
- [With PHE to End Mid-May, DEA Prepares to Propose New Telehealth Rules](https://aimedalliance.org/with-phe-to-end-mid-may-dea-sets-to-propose-telehealth-rule/) - On January 30, 2023, the Biden Administration announced that the COVID-19 public health emergency (PHE) will end on May 11, 2023. The PHE was originally set to expire on April 11, but the Administration announced its plan to extend the emergency declaration to prevent an abrupt end to policy flexibilities enacted during the PHE. The
- [Survey Finds Nearly Half of Women Forgo Preventive Care](https://aimedalliance.org/survey-finds-nearly-half-of-women-forgo-preventive-care/) - A recent survey conducted by Ipsos, reported finding that 45 percent of American women skip preventative care services like check-ups, cancer screenings and vaccinations, often due to high out-of-pocket costs and time restraints. The report also found that social determinants of health also contribute to disparities in preventative care. For example, the survey found that
- [Aimed Alliance Comments on Essential Health Benefits RFI](https://aimedalliance.org/aimed-alliance-releases-comments-on-essential-health-benefits-rfi/) - On January 30, 2023, Aimed Alliance submitted a comment to the Centers for Medicaid and Medicare Services (CMS) and the Department of Health and Human Services (HHS) regarding their request for information on essential health benefits. Our comment highlighted the need for CMS and HHS to clarify that specialty drugs are included within the essential
- [Aimed Alliance Comments on 2024 NBPP](https://aimedalliance.org/aimed-alliance-comments-on-2024-nbpp/) - On January 31, 2023, Aimed Alliance submitted a comment to the Centers for Medicaid and Medicare Services (CMS) and the Department of Health and Human Services (HHS) on the 2024 Notice of Benefit and Payment Parameters. Our comment supported expanding essential community providers to include mental health and substance use disorder providers, and expanding support
- [Step-Therapy Bills Reintroduced in New York](https://aimedalliance.org/four-step-therapy-bills-reintroduced-in-new-york/) - In January 2023, Senator Breslin and Assemblyman McDonald reintroduced four step-therapy bills that would create additional protections for patients in New York. The bills include: - S.2682/A.582: Prohibits the applicability of step therapy policies to certain therapeutic categories, including dermatology, gastroenterology, hematology, neurology, oncology, ophthalmology, and rheumatology - S.2800/A.1384: Requires insurers and utilization review agents to
- [Aimed Alliance Releases 2022 Annual Impact Report](https://aimedalliance.org/aimed-alliance-releases-2022-annual-impact-report/) - In 2022, Aimed Alliance engaged in a wide variety of activities to protect and enhance the rights of health care consumers and providers, and to ensure that in the growing age of technology and healthcare, patients and providers always remain the priority. We are pleased to share our 2022 Annual Impact Report, which highlights the
- [Aimed Alliance Releases New Texas Gold Card Resource for Providers](https://aimedalliance.org/aimed-alliance-releases-new-texas-gold-card-resource-for-providers/) - In 2022, Texas passed and implemented a gold-card law to help reduce health care providers prior authorization administrative burdens. To ensure providers are aware of their rights and benefits under this new law, Aimed Alliance has developed the below fact sheet containing important information regarding this new law. Read the new fact sheet here.
- [NIH Supports Broad Portfolio of Cannabis Research](https://aimedalliance.org/nih-supports-broad-portfolio-of-cannabis-research/) - The National Institutes of Health (NIH) demonstrated its support for a broad range of research on cannabis, cannabinoids, and related compounds. The research supports examining the whole or parts of the Cannabis sativa plan, extracts and enriched extracts from cannabis, cannabinoid compounds derived from cannabis extracts, non-cannabinoid elements of cannabis, synthetic cannabinoids, and components of
- [FDA Publishes Final Guidance on Considerations for Clinical Research on Cannabis](https://aimedalliance.org/fda-publishes-final-guidance-on-considerations-for-clinical-research-on-cannabis/) - On January 23, 2023, the Food and Drug Administration (FDA) published a final guidance for industry, “Cannabis and Cannabis-Derived Compounds: Quality Considerations for Clinical Research.” The 2018 Farm Bill removed hemp from the definition of marijuana under the Controlled Substances Act. Therefore, hemp is no longer a controlled substance under federal law. Hemp includes cannabis
- [Report Suggests Fair Access Criteria as Effective Tool to Encourage Increased Drug Access](https://aimedalliance.org/report-suggests-fair-access-criteria-as-effective-tool-to-encourage-increased-drug-access/) - On January 17, 2023, the Institute for Clinical and Economic Review (ICER) published its second annual “Barriers to Fair Access” assessment of prescription drug coverage policies. The report evaluated coverage policies for 19 drug-indication pairs across 18 formularies, finding that major coverage policies demonstrated a high level of concordance with ICER’s fair access criteria. ICER
- [Advocates File Class Action Against Iowa for Lack of Youth Mental Health Resources](https://aimedalliance.org/advocates-file-class-action-against-iowa-for-lack-of-youth-mental-health-resources/) - On January 6, 2023, children’s rights advocates Disability Rights Iowa, Children’s Rights, National Health Law Program, and Ropes & Gray, LLP, filed a class action lawsuit against the Iowa Department of Health and Human Services for allegedly denying Medicaid-eligible children their right to mental health care. The advocates filed the class-action on behalf of Medicaid-eligible
- ["We must protect NY patients from health insurers’ coverage limitations"](https://aimedalliance.org/we-must-protect-ny-patients-from-health-insurers-coverage-limitations/) - On January 5, 2022, Aimed Alliance Counsel, Ashira Vantrees, authored an op-ed which called on the New York legislature to protect patients from health insurance policies that limit consumer's access to life-saving treatments. While applauding the New York legislature for passing copay accumulator reform in 2022, the piece recognizes the need for the legislature to
- [Federal Court Limits ACA Mandated Coverage for Preventative Care](https://aimedalliance.org/the-uncertainty-for-the-future-of-the-aca-mandated-coverage-for-preventative-care/) - The future of the Patient Protection and Affordable Act’s (ACA) preventative care coverage requirements could be in jeopardy after a federal judge ruled that certain provisions of the mandate were unconstitutional. Section 2713 of the ACA requires most health insurers, including ERISA-regulated group health plans, to cover a variety of preventive services without cost sharing,
- [New ADA and FMLA Resources for Patients with IBD](https://aimedalliance.org/new-ada-and-fmla-resources-for-patients-with-ibd/) - In conjunction with Aimed Alliance's “Health Equity in IBD” project, Aimed Alliance has developed new resources for patients with IBD. These new resources include (1) a brochure on the Americans with Disabilities Act and how some individuals with IBD may qualify for these protections; (2) a brochure on the Family Medical Leave Act which permits
- [New Resources to Help Employers Understand Risks of Cannabinoids](https://aimedalliance.org/new-resources-to-help-employers-understand-risks-and-benefits-of-cbd-coverage/) - On December 6, Aimed Alliance released two new resources to help employers and human resources professionals assess coverage of cannabidiols and work place risks. The "Cannabinoid Insurance Coverage Mandates: Legal Considerations" discusses federal and states laws and regulations governing cannabinoids, while the "Cannabinoids: A Fact Sheet for Health Care Decision Makers" provides a more detailed
- [New Resource Analyzes If Copay Accumulator Bans Impact Health Insurance Premiums](https://aimedalliance.org/new-resource-analyzes-if-copay-accumulators-bans-impact-health-insurance-premiums/) - On November 29, 2022, Global Healthy Living Foundation (GHLF) launched a free, interactive tool analyzing how state laws prohibiting copay accumulator and maximizers have affected health insurance premiums. The tool examines how insurance premiums have fluctuated between 2014 and 2022, in states that have passed copay accumulators bans. Overall, the analysis found that state laws
- [Aimed Alliance Releases New Gold Card Tool](https://aimedalliance.org/aimed-alliance-releases-new-gold-card-tool/) - On December 22, Aimed Alliance released a new resource on gold card laws across the United States. This new resource provides an analysis of passed, proposed, and failed gold card legislation from 2019-2022. The new resource is available here.
- [Aimed Alliance Hosts Discussion on Step Therapy Reform in New York](https://aimedalliance.org/aimed-alliance-hosts-discussion-on-step-therapy-reform-in-new-york/) - On October 17, 2022, the New York Step Therapy Alliance hosted a roundtable meeting to discuss the current state of step-therapy law and reform efforts in New York; the impact of step-therapy on patients; how step-therapy protocols can be inconsistent with clinical best practices; health care providers’ perspectives and experiences; and how to achieve legislative
- [Report Underscores Disproportionate Claim Denial Rates for Black and Hispanic Patients](https://aimedalliance.org/report-underscores-disproportionate-claim-denial-rates-in-patients-of-color/) - A report released by the Institute for Patient Access underscores the disproportionate claim rejection rates and subsequent health outcomes in communities of color. The report, which analyzed Medicare and commercial health plan pharmacy claims for 3.74 million people living with asthma, chronic kidney disease, or cardiovascular disease found that Black and Hispanic patients are more
- [Available Online Now: Cannabis, CBD, and Cannabinoids: What Employers and Consumers Should Know](https://aimedalliance.org/available-online-now/) - On December 6, Aimed Alliance hosted a webinar on HR.com titled Cannabis, CBD, and Cannabinoids: What Employers and Consumers Should Know. View the webinar below. https://www.youtube.com/watch?v=0kpd4GV7ZBo
- [Aimed Alliance Submits Written Testimony in Ohio Senate Hearing on Copay Accumulators](https://aimedalliance.org/aimed-alliance-submits-written-testimony-to-ohio-senate-hearing/) - On November 28, Aimed Alliance submitted written testimony to the Ohio Senate supporting the passage of HB 135 which would require all third-party assistance to count towards meeting a patients cost-sharing requirements. Read Aimed Alliance's written testimony here.
- [CMS Proposes Rule to Improve Prior Authorization Policies ](https://aimedalliance.org/cms-proposes-rule-to-improve-prior-authorization-policies/) - On December 13, 2022, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule to modernize prior authorization processes for Medicare Advantage plans, Medicaid fee-for-service programs, Medicaid plans and exchange plans. The rule would streamline prior authorization processes for medical drugs and procedures by requiring payers to: (1) implement an electronic prior authorization
- [Additional Research is Needed Before Permanent Telehealth Policies Are Adopted](https://aimedalliance.org/research-gaps-hinder-adoption-of-permanent-telehealth-policies/) - While legislators have extended many COVID-19 telehealth polices through 2024, there are still many questions that should be answered about the long-term future of telemedicine. Throughout the discussions of telehealth usage and its expansion, the concern of a lack of data on telehealth outcomes has been consistently raise. A perspective piece published in The New
- [Lawsuit Update: Georgia's Medicaid Work Requirement Goes Into Effect July, 1 2023](https://aimedalliance.org/lawsuit-update-georgias-medicaid-work-requirement-goes-into-effect-july-1-2023/) - On August 2022, the U.S. District Court for the Southern District of Georgia sided with the State of Georgia holding that the rescission of the 1115 waivers was arbitrary, and that CMS failed to consider that rescinding the program could mean less Medicaid coverage in Georgia. CMS has declined to appeal the decision. As a
- [20 Organizations Urge Senate to Expand Access to Treatments for OUD](https://aimedalliance.org/20-organizations-urge-senate-to-expand-access-to-treatments-for-oud/) - On November 2, Aimed Alliance hosted a legislative briefing on facilitating access to medications for opioid use disorders (“MOUD”). The objective of this legislative briefing was to educate patient and professional advocacy groups on the state of drug poisoning in the United States, and the need for the United States Senate to pass S.3257. The
- [Upcoming Webinar: Cannabis, CBD, and Cannabinoids: What Employers and Consumers Should Know](https://aimedalliance.org/upcoming-webinar-cannabis-cbd-and-cannabinoids-what-employers-and-consumers-should-know/) - Join Aimed Alliance for a Free Advocacy Briefing on Cannabis, CBD, and Cannabinoids: What Employers and Consumers Should Know December 6, 2022 from 3PM-4PM ET. As HR professionals contemplate workplace decisions that affect employee compensation, wellness, and safety, various questions about cannabis, marijuana, hemp, and cannabinoids may arise. Similarly, as HR specialists and employees personally
- [Upcoming Webinar: Essential Health Benefits, Importation, and More – Do You Know the Risks?](https://aimedalliance.org/upcoming-webinar-essential-health-benefits-importation-and-more-do-you-know-the-risks/) - Join Aimed Alliance for a Free HR.com Webinar: Essential Health Benefits, Importation, and More – Do You Know the Risks? December 13, 2022 from 11AM-12PM ET. Surveys have shown that employers consider health care to be the single most important employee benefit area, and for good reason. For the majority of individuals with employer-sponsored health
- [FDA Issues Warning to CBD Manufacturer](https://aimedalliance.org/fda-issues-warning-to-cbd-manufacturer/) - The U.S. Food and Drug Administration (FDA) has issued a warning letter to a company that sells products with fraudulent claims to prevent, treat, mitigate, diagnose, or cure COVID-19. On November 1, the FDA issued Alternative Health Distribution LLC d/b/a CannaAid, which markets cannabinoid products, including cannabidiol (CBD) products, to mitigate, prevent, treat, diagnose, or
- [Bill to Expand Cannabinoid Research Goes to President](https://aimedalliance.org/bill-to-expand-cannabinoid-research-goes-to-president/) - On November 16, 2022, the U.S. Senate approved the House-passed bipartisan Medical Marijuana and Cannabidiol Research Expansion Act (H.R. 8454). The bill creates a separate, streamlined registration process to facilitate research on cannabinoids. Specifically, the bill: Permits registered entities to manufacture, distribute, dispense, or possess marijuana or cannabidiol (CBD) for medical research purposes; Prohibits the
- [Aimed Alliance Featured in Leaders Edge](https://aimedalliance.org/aimed-alliance-featured-in-leaders-edge/) - On November 11, Aimed Alliance was featured in Leader's Edge. Leader's Edge is an award-winning content platform for The Council of Insurance Agents & Brokers, covering legal and legislative issues, international business and regulation, management trends and best practices, technology, and more. Leader’s Edge is written for large and mid-sized commercial insurance and employee benefit executives
- [Aimed Alliance Urges Senators to Expand Access to Treatments for OUD](https://aimedalliance.org/senators-expand-access-to-treatments-for-oud/) - On November 2, 2022, Aimed Alliance hosted a legislative briefing on facilitating access to medications for opioid use disorders (“MOUD”). Aimed Alliance is a non-profit health policy organization that seeks to protect and enhance the rights of healthcare consumers and providers. The objective of this legislative briefing was to educate patient and professional advocacy groups
- [Upcoming Advocacy Briefing: S.3257 Facilitating Access to MOUD Treatments](https://aimedalliance.org/upcoming-advocacy-briefing-s-3257-facilitating-access-to-moud-treatments/) - Join Aimed Alliance for a Free Advocacy Briefing on S.3257 to Facilitate Access to Medication for Opioid Use Disorder (MOUD) November 2, 2022 from 2PM-3PM ET. Aimed Alliance will host a briefing on S.3257, a federal bill to facilitate access to medications for opioid use disorder (MOUD). The one-hour briefing is intended to inform and engage
- [Aimed Alliance Releases Updated Open Enrollment Brochures](https://aimedalliance.org/aimed-alliance-releases-updated-open-enrollment-brochures-2/) - The open enrollment periods for individual, small, large group, and Medicare plans have recently opened for 2023 enrollment! To ensure consumers are able to select the plan that is most appropriate for their needs, we have updated our various brochures, including the following: “Open Enrollment: Understanding Your Health Plan and Your Cost-Sharing Responsibilities” – This brochure
- [Upcoming HR.com Webinar: Cannabis, CBD, and Cannabinoids: What Employers and Consumers Should Know](https://aimedalliance.org/upcoming-hr-com-webinar-cannabis-cbd-and-cannabinoids-what-employers-and-consumers-should-know/) - Join Aimed Alliance for a Free Webinar on Cannabis, CBD, and Cannabinoids: What Employers and Consumers Should Know December 6, 2022 from 3PM-4PM ET. As HR professionals contemplate workplace decisions that affect employee compensation, wellness, and safety, various questions about cannabis, marijuana, hemp, and cannabinoids may arise. Similarly, as HR specialists and employees personally care
- [Aimed Alliance Comments On Section 1557 Proposed Rule](https://aimedalliance.org/aimed-alliance-comments-on-hhss-section-1557-proposed-rule/) - On October 3, 2022, Aimed Alliance submitted a comment to the Department of Health and Human Services (HHS) on its' proposed Section 1557 Rule. Section 1557 of the Patient Protection and Affordable Care (ACA) prohibits discrimination on the basis of race, color, national origin, age, disability or sex (including pregnancy, sexual orientation, gender identity, and
- [FDA Asks Congress for New Authority To Regulate CBD](https://aimedalliance.org/fda-asks-congress-for-new-authority-to-regulate-cbd/) - When addressing the Food and Drug Administration’s (FDA) reluctancy to develop new regulations for cannabidiol (CBD), FDA Commissioner Robert Califf testified before a House Appropriations subcommittee, on May 19, 2022, stating, “I don’t think the current authority [FDA] ha[s], on the food side and the drug side, necessarily gives us what we need to have
- [OIG Releases Report on Opioid Use Disorders in Medicare Part D Beneficiaries](https://aimedalliance.org/oig-releases-report-on-opioid-use-disorders-in-medicare-part-d-beneficiaries/) - Recently, the Department of Health and Human Services, Office of Inspector General (OIG) released a new report on opioid-related drug poisonings and deaths in Medicare beneficiaries. The report found that in 2021, over 50,000 Medicare Part D beneficiaries experienced an overdose from prescription opioids, illicit opioids, or both. The report also found that of the
- [FTC Holds Health Care Marketing Firm Responsible for Misleading Consumers](https://aimedalliance.org/ftc-holds-health-care-marketing-firm-responsible-for-misleading-consumers/) - Recently, the Federal Trade Commission (FTC) took action against Benefytt Technologies for selling “sham” health care plans. According to the FTC complaint, Benfeytt Technologies and their marketing partners operated deceptive websites, such as “Obamacareplans.com,” that targeted consumers looking for comprehensive Patient Protection and Affordable Care Act (ACA) compliant health plans. Qualified ACA plans must meet
- [Draft Recommendations by U.S. Preventative Services Task Force Propose Free Coverage of Mental Health Screenings](https://aimedalliance.org/draft-recommendations-by-u-s-preventative-services-task-force-propose-free-coverage-of-mental-health-screenings/) - New recommendations released by the U.S. Preventative Services Task Force (USPSTF) propose that all adults be screened for depression, and those under the age of 65 also be screened for anxiety. The Affordable Care Act (ACA) requires that all USPSTF recommendations with an “A” or “B” grade be covered with no cost-sharing to enrollees. Here,
- [Aimed Alliance Featured in LA Daily News Article](https://aimedalliance.org/aimed-alliance-featured-in-la-daily-news-article/) - Aimed Alliance Counsel, Ashira Vantrees, was quoted in a recent article by Courtney Perkes in the Los Angeles Daily News. The article discusses how patients in California can challenge their health plan’s claim denials. The piece quotes Ms. Vantrees as stating, “Often patients are unaware of their health plan’s appeals process because health plans are
- [Aimed Alliance Submits Comment on Medicare Physician Fee Schedule](https://aimedalliance.org/aimed-alliance-submits-comment-on-medicare-physician-fee-schedule/) - On September 2, Aimed Alliance submitted a letter to the Centers for Medicare and Medicaid Services on the 2023 Medicare Physician Fee Schedule Proposed Rule. Our letter supported a balanced approach to maintain access to telehealth services and continuing access to vaccines through the at-home COVID-19 vaccination program. Additionally, our letter cautioned against lowering reimbursements
- [Aimed Alliance Asks DC Council for Copay Accumulator and Prior Authorization Reform](https://aimedalliance.org/aimed-alliance-asks-dc-council-for-copay-accumulator-and-prior-authorization-reform/) - On September 20, Aimed Alliance sent two letters to the District of Columbia Council Committee on Health. Our letters supported the Council adopting a copay accumulator ban and reforming the prior authorization process in DC. Our prior authorization letter can be read here, and our copay accumulator ban letter can be read here.
- [Step Therapy Reform: Rheumatological Conditions](https://aimedalliance.org/step-therapy-reform-rheumatological-conditions/) - Requiring patients with rheumatological conditions to try and fail alternative treatments before the insurer or pharmacy benefit manager will cover the originally prescribed treatment can force patients with rheumatological conditions to continue experiencing symptoms such as significant joint and organ destruction, severe pain, and disability. The lack of symptom relief caused by step-therapy policies
- [Step Therapy Reform: Ophthalmological Conditions](https://aimedalliance.org/step-therapy-reform-ophthalmological-conditions/) - Mandating patients with ophthalmological conditions undergo step therapy can result in disease progression requiring more extensive and expensive care, and higher out-of-pocket costs for patients. Some plans also create burdensome protocols, for ophthalmological conditions such as requiring patients to lose more than “15 letters of visual acuity” or fail on three different treatments before
- [Step Therapy Reform: Oncological Conditions](https://aimedalliance.org/step-therapy-reform-oncological-conditions/) - Requiring patients with oncological conditions to try and fail on less effective treatments before the prescribed treatment is covered poses major health risks, including disease progression, perpetuation of symptoms, and premature death. Additionally, it can also increase overall costs of care by requiring patients to undergo additional tests and procedures when treatments are ineffective. Learn
- [Step Therapy Reform: Neurological Conditions](https://aimedalliance.org/step-therapy-reform-neurological-conditions/) - Mandating patients with neurological conditions try and fail on alternative treatments can undercut a provider’s careful consideration of factors, such as potential side effects, route of administration, and disease progression, which can have significant negative impacts on patients, and in some cases, cause damage to the central nervous system. Learn more by reading our fact
- [Step Therapy Reform: Hematological Conditions](https://aimedalliance.org/step-therapy-reform-hematological-conditions/) - Requiring patients to “fail first” on alternative treatments can be particularly harmful and burdensome for patients with hematological conditions, who need highly individualized care. Requiring patients with hematological conditions to try and fail may cause a patient’s condition to relapse, force a patient to endure severe daily pain, and may even lead to fatal outcomes.
- [Step Therapy Reform: Gastroenterological Conditions](https://aimedalliance.org/step-therapy-reform-gastroenterological-conditions/) - Mandating patients with gastroenterological conditions undergo step therapy before the prescribed treatment is covered may result in significant discomfort, hospitalization, and additional costs for patients with gastrointestinal diseases. Read the fact sheet to learn more here.
- [Step Therapy Reform: Dermatological Conditions](https://aimedalliance.org/step-therapy-reform-dermatological-conditions/) - Requiring patients with dermatological conditions to try and fail alternative treatments before the insurer or pharmacy benefit manager will cover the prescribed treatment may cause chronic skin conditions to worsen, undermine patients’ quality of life, and delay access to effective treatments. Read our fact sheet here to learn more.
- [Step Therapy Reform: Clinical Peer Review of Step Therapy Decision Making](https://aimedalliance.org/step-therapy-reform-clinical-peer-review-of-step-therapy-decision-making/) - In 2022, the New York Legislature passed S8113 and A879 which requires a clinical peer-reviewer to be a licensed health care professional in the same profession and same or similar specialty as the health care provider who typically manages the medical condition or disease or provides the health care service or treatment under review.
- [Upcoming HR.com Webinar: Health Benefits: The Hidden Costs of “Cost-Saving” Programs](https://aimedalliance.org/health-benefits-the-hidden-costs-of-cost-saving-programs/) - Join Aimed Alliance and the Alliance for Patient Access (AfPA) for a Free Webinar on Health Benefits: The Hidden Costs of “Cost-Saving” Programs October 20, 2022 from 2PM-3PM ET. Employer-sponsored health insurance covers nearly 155 million people in the United States.1 Providing comprehensive health plan benefits and coverage is an important tool for employers to
- [Aimed Alliance Submits Amicus Brief in Lawsuit to Enjoin Non-EHB Program](https://aimedalliance.org/aimed-alliance-submits-amicus-brief-in-lawsuit-to-enjoin-non-ehb-program/) - On August 16, Aimed Alliance, along with six other patient advocacy organizations, requested permission from the United States District Court for the District of New Jersey to file an amicus brief on the impacts of non-EHB programs like SaveOnSP’s. The amicus brief addresses how SaveOnSP’s conduct deceives, influences, and harms consumers, and how SaveOnSP’s conduct
- [Aimed Alliance Publishes Cannabinoid Fact Sheet](https://aimedalliance.org/aimed-alliance-publishes-cannabinoid-fact-sheet/) - CBD, delta-8-THC, and other cannabinoid products are widely advertised and available. Some are marketed with unproven medical claims, while others are promoted for their intoxicating effects. To help consumers make informed decisions, Aimed Alliance published "Cannabinoids: A Fact Sheet for Consumers." This new resource defines cannabinoids and discusses their legal status and potential health effects.
- [Aimed Alliance Releases New Fact Sheet on Mental Health and Non-Medical Switching](https://aimedalliance.org/aimed-alliance-releases-new-fact-sheet-on-mental-health-and-non-medical-switching/) - On August 12, Aimed Alliance released a new fact sheet titled "Protect Patients with Mental Health Conditions by Prohibiting Non-Medical Switching." This new fact sheet reviews how health plans forcing patients to switch medications for financial rather than medical reasons can impact a patient's health stability. Read the new fact sheet here.
- [Aimed Alliance and PACH host HR.com Webinar on: Reducing Health Care Barriers in a Diverse Workforce with Peripheral Artery Disease ](https://aimedalliance.org/aimed-alliance-and-pach-host-hr-com-webinar-on-reducing-health-care-barriers-in-a-diverse-workforce-with-peripheral-artery-disease/) - On June 16, 2022, Aimed Alliance and the Partnership to Advance Cardiovascular Health hosted a webinar on HR.com titled "Reducing Health Care Barriers in a Diverse Workforce with Peripheral Artery Disease." View the webinar below. https://www.youtube.com/watch?v=ariUduUtKdY
- [Aimed Alliance Releases New Non-EHB Fact Sheet](https://aimedalliance.org/aimed-alliance-releases-new-non-ehb-fact-sheet/) - On July 20, 2022, Aimed Alliance released a new fact sheet titled "How A Loophole in the Patient Protection and Affordable Care Act Can Impact Access To Your Necessary Treatments." This new fact sheet reviews how some health plans define specialty medications as non-essential health benefits under the ACA, and how state and federal legislation
- [New Insurance Pricing Transparency Requirements Could Help Patients and Employers Save Money](https://aimedalliance.org/new-insurance-pricing-transparency-requirements-could-help-patients-and-employers-save-money/) - On Friday, July 1, 2022, the first phase of the Transparency in Coverage Final Rule, issued by the Centers for Medicare and Medicaid Services (CMS), went into effect. This phase requires employers and health insurers to publish their negotiated rates with hospitals and the amounts paid to out-of-network providers. Phase two, to be implemented in
- [House Ways and Means Committee Focuses on Misleading Marketing Tactics From Junk Insurance Plans](https://aimedalliance.org/house-ways-and-means-committee-focuses-on-misleading-marketing-tactics-from-junk-insurance-plans/) - “Junk health plans” are health insurance policies known Association Health Plans and short-term plans. Typically, these junk plans contain fewer treatment and services than consumers anticipate, and short-term plans are exempt from the definition of individual health insurance coverage under the Patient Protection and Affordable Care Act (ACA). As such, these “junk plans” may discriminate
- [Did COVAX increase global vaccine equity?](https://aimedalliance.org/did-covax-increase-global-vaccine-equity/) - Created by the World Health Organization (WHO), Gavi, and the Coalition for Epidemic Preparedness Innovations (CEPI), the COVID-19 Vaccines Global Access (COVAX) works to improve the equity of COVID-19 vaccine access globally. However, this initiative has not been as successful as initially envisioned, with less than 10 percent of the population in low-income countries currently
- [Aimed Alliance Joins Chronic Disease Coalition to Discuss Workplace Discrimination](https://aimedalliance.org/aimed-alliance-joins-chronic-disease-coalition-to-discuss-workplace-discrimination/) - On June 23, 2022, Aimed Alliance Staff Attorney, Ashira Vantrees, participated in a Chronic Disease Coalition Chronic University Webinar on Workplace Discrimination. Watch a recording of the webinar here.
- [Aimed Alliance Releases 2021 Annual Report](https://aimedalliance.org/aimed-alliance-releases-2021-annual-report/) - In 2021, Aimed Alliance engaged in a wide variety of activities to protect and enhance the rights of health care consumers and providers, and to ensure that in the growing age of technology and healthcare, patients and providers always remain the priority. We are pleased to share our 2021 Annual Report, which highlights the progress
- [Federal Trade Commission Launches Inquiry Into Six PBMs](https://aimedalliance.org/ftc-launches-inquiry-into-six-pbms/) - On June 7, 2022, the Federal Trade Commission (FTC) launched an inquiry into six of the largest pharmacy benefit managers (PBMs). The FTC requested these PBMs provide information on their business practices to the FTC including how PBMs: (1) charge fees and clawbacks to unaffiliated pharmacies; (2) employ methods to steer patients towards PBM owned
- [Upcoming Webinar: Reducing Health Care Barriers in a Diverse Workforce with Peripheral Arterial Disease](https://aimedalliance.org/upcoming-webinar-reducing-health-care-barriers-in-a-diverse-workforce-with-peripheral-arterial-disease/) - Join Aimed Alliance and the Partnership to Advance Cardiovascular Health (PACH) for a Free Webinar on June 16, 2022 from 12PM-1PM ET. For employers, a diverse workforce is important for maintaining a variety of perspectives, increasing creativity and productivity, and attracting and retaining talented employees. Now, during the Great Resignation, it is more important than
- [The American Hospital Association Calls for Action on Prior Authorizations in Medicare Advantage Plans](https://aimedalliance.org/the-american-hospital-association-calls-for-action-on-prior-authorizations-in-medicare-advantage-plans/) - On May 19, 2022, the American Hospital Association (AHA) sent a letter to the Administrator of the Centers for Medicare and Medicaid Services (CMS) requesting CMS take “swift action to hold Medicare Advantage (MA) plans accountable for inappropriately and illegally restricting beneficiary access to medically necessary care” through improper and excessive denials of prior authorizations.
- [Health Affairs Re-Releases Article on The Effects of Violence on Health](https://aimedalliance.org/health-affairs-re-releases-article-on-the-effects-of-violence-on-health/) - Whether directly or indirectly experienced, violence can have a negative impact on the health of individuals and communities. For example, an article in Health Affairs found that exposure to violence can result in individuals living in a state of hypervigilance. The article also found that for children, exposure to violence at a younger age can
- [New Report Explains How Prescription Digital Therapies Differ From Wellness Apps](https://aimedalliance.org/new-report-explains-how-prescription-digital-therapies-differ-from-wellness-apps/) - In May 2022, the Digital Therapeutics Alliance released a report titled DTx Value Assessment & Integration Guide. This new report provides a framework for how health care decision-makers can assess emerging digital therapeutics, including information that should be considered when evaluating digital therapies, and a benchmark system to compare prescription digital therapeutics. The report also
- [New Study Provides Information on the Impact of CBD on Consumer’s Health](https://aimedalliance.org/new-study-provides-information-on-the-impact-of-cbd-on-consumers-health/) - In March 2020, the U.S. Food and Drug Administration (FDA) recognized the need for more data to address the gaps in current research related to the safety of cannabidiol (CBD). Therefore, the FDA sought to collaborate with relevant stakeholders to gather data and address these gaps. Specifically, the FDA aimed to engage stakeholders to address
- [Aimed Alliance Releases Biomarker Testing Fact Sheet](https://aimedalliance.org/aimed-alliance-releases-biomarker-testing-fact-sheet/) - On June 2, 2022, Aimed Alliance released a new fact sheet on biomarker testing titled "Increase Access to Precision Medicine for Patients with Cancer Through Biomarker Testing." This new fact sheet reviews the benefits of biomarker testing for patients with cancer and the current limitations to receiving biomarker testing as a result of limited health
- [Conversation with Aimed Alliance Featured in Patient Empowerment Network Activity Guide on Health Policy](https://aimedalliance.org/conversation-with-aimed-alliance-featured-in-patient-empowerment-network-activity-guide/) - Aimed Alliance’s staff attorney, Ashira Vantrees, spoke with the Patient Empowerment Network for their May 2022 Activity Guide on “How Does Health Policy Impact Me?” Ashira spoke with patient advocate, Mary Leer, regarding the importance of the Cancer Drug Parity Act; the Patient Protection and Affordable Care Act (“ACA”); and the need for health care
- [FDA Sends Warning Letters to Four Companies for Selling Unapproved CBD Products](https://aimedalliance.org/fda-sends-warning-letters-to-four-companies-for-selling-unapproved-cbd-products/) - On May 26, the Food and Drug Administration (FDA) sent warning letters to Free State Oils, Kingdom Harvest, Kahm CBD, and Hope Botanicals for illegally selling unapproved animal drugs containing cannabidiol (CBD) that are intended for use in food-producing animals. In its letter, the FDA explained that there is currently a lack of research available
- [CCSS Sends Letter of Support for Dietary Supplement Listing Act of 2022](https://aimedalliance.org/ccss-sends-letter-of-support-for-dietary-supplement-listing-act-of-2022/) - On May 18, the Collaborative for Cannabinoid Science and Safety (CCSS) sent a letter to U.S. Senators Durbin and Braun commending their introduction of the Dietary Supplement Listing Act of 2022 (S.4090). If passed, this bill would require dietary supplement manufacturers to list their products with the Food and Drug Administration (FDA). Read the full
- [Report Examines Consequences of Non-Medical Switching for Patients with Mental Health Conditions](https://aimedalliance.org/report-examines-consequences-of-non-medical-switching-of-mental-health-medications/) - A new report from the Alliance for Mental Health Care Access entitled The Dangers of Non-Medical Switching for Mental Health Patients examines the effects of non-medical switching on patients with mental health conditions. The report illuminates the harmful side effects and expensive consequences of the practice. For example, more than 40 percent of patients surveyed reported
- [Aimed Alliance summarizes Johnson & Johnson’s lawsuit against SaveOnSP](https://aimedalliance.org/aimed-alliance-summarizes-johnson-johnsons-lawsuit-against-saveonsp/) - On May 4, 2022, Johnson & Johnson filed a complaint in the United States District Court of New Jersey against SaveOnSP over SaveOnSP’s copay maximizer program. Johnson & Johnson is seeking damages and asking the Court to prohibit SaveOnSP from continuing its maximizer program for Johnson & Johnson’s/Jansseen’s drugs. To learn more about the case
- [Aimed Alliance adds FAQ to Copay Accumulator 101 Hub](https://aimedalliance.org/aimed-alliance-adds-faq-to-copay-accumulator-101-hub/) - On May 15, 2022, Aimed Alliance updated its Copay Accumulator 101 Hub to include a Frequently Asked Questions (FAQ) section. The new FAQ section answers a wide variety of questions—from how a consumer can review their plan materials to determine if their plan uses a copay accumulator to how consumers can convince their employers that
- [Aimed Alliance Releases New Maps on Biomarker Testing](https://aimedalliance.org/aimed-alliance-releases-new-maps-on-biomarker-testing/) - On May 10, 2022, Aimed Alliance launched two new maps to track active and enacted biomarker legislation. Biomarker testing can be used to identify genes, proteins, or other substances that provide information about a person’s cancer. This testing provides important information that can help health care providers select and monitor appropriate treatments, which helps providers
- [Aimed Alliance Speaks at HealthyWomen's Cures 2.0 Virtual Policy Discussion](https://aimedalliance.org/aimed-alliance-speaks-at-healthywomens-cures-2-0-virtual-policy-discussion/) - On May 11, 2022, Aimed Alliance's staff attorney, Ashira Vantrees, participated as a panelist on Healthy Women's Virtual Policy Discussion titled: "Cures 2.0 Leading Women's Health Forward." View the webinar below. https://www.youtube.com/watch?v=d9-uvTNQG1Y&t=3131s
- [Food and Drug Administration Issues Guidance on Race and Ethnicity Diversity Plans for Clinical Trials](https://aimedalliance.org/food-and-drug-administration-issues-guidance-on-race-and-ethnicity-diversity-plans-for-clinical-trials/) - On April 13, the Food and Drug Administration published a draft guidance on “Diversity Plans to Improve Enrollment of Participants from Underrepresented Racial and Ethnic Populations in Clinical Trials Guidance for Industry.” The guidance provides recommendations to sponsors developing human drugs and medical devices on the approach for creating Race and Ethnicity Diversity Plans (Plans)
- [White House Proposes to Fix “Family Glitch” in the ACA](https://aimedalliance.org/white-house-proposes-to-fix-family-glitch-in-the-aca/) - On April 5, 2022, the Biden Administration announced that the Treasury Department and the Internal Revenue Service (IRS) proposed a rule that would end the “family glitch” in the Patient Protection and Affordable Care Act (ACA). Under the ACA, if an individual does not have access to “affordable” health insurance through their employer, then they
- [AHIP Pushes Back on HHS Efforts To Ensure Non-Discrimination in Plan Design](https://aimedalliance.org/ahip-pushes-back-on-hhs-efforts-to-ensure-non-discrimination-in-plan-design/) - In its 2023 Notice of Benefit and Payment Parameters Proposed Rule (2023 NBPP), the U.S. Department of Health and Human Services (HHS) proposed to refine the essential health benefit (EHB) nondiscrimination policy to ensure consistent application of the policy and better protect against discriminatory practices. Current CMS rules state that an issuer does not provide
- [Michigan Expands Postpartum Coverage for Up To 12 Months](https://aimedalliance.org/michigan-expands-postpartum-coverage-for-up-to-12-months/) - On April 14, 2022, Michigan joined a growing number of states that can now offer Medicaid and Children’s Health Insurance Program (CHIP) coverage for up to 12 months after a beneficiary gives birth. CMS estimates that nearly 16,000 pregnant and postpartum people in Michigan will be eligible for this expanded coverage, made possible through a
- [Aimed Alliance Sends Letter of Support to Minnesota Legislature on Copay Accumulator Reform](https://aimedalliance.org/aimed-alliance-sends-letter-of-support-to-minnesota-legislature-on-copay-accumulator-reform/) - On March 25, 2022, Aimed Alliance sent a letter to the Minnesota House of Representatives Commerce Finance and Policy Committee supporting the Minnesota All Copays Count Coalition and encouraging the Minnesota legislature to pass copay accumulator reform. When patients cannot afford their medications, they may rely on financial assistance from pharmaceutical manufacturers and other third
- [Aimed Alliance Hosts Webinar on Covering Prescription Digital Therapeutics: A Win-Win for Employers and Employees](https://aimedalliance.org/aimed-alliance-hosts-webinar-on-covering-prescription-digital-therapeutics-a-win-win-for-employers-and-employees/) - On March 29, 2022, Aimed Alliance hosted a webinar through HR.com titled "Covering Prescription Digital Therapeutics: A Win-Win for Employers and Employees.” View the webinar below. https://www.youtube.com/watch?v=sGAzdDEitL0
- [New Resources Educate Decisionmakers on Insurance Coverage of Rx Digital Therapies](https://aimedalliance.org/new-resources-educate-decisionmakers-on-insurance-coverage-of-rx-digital-therapies/) - Aimed Alliance Teams with HR.com, Center for U.S. Policy, Others To Inform Corporate Executives, Members of Congress WASHINGTON, March 28, 2022 /PRNewswire/ -- On Tuesday, March 29, at 1 p.m. ET, Aimed Alliance will host a free webinar on HR.com to educate human resources (HR) professionals on the advantages of providing health insurance coverage of prescription digital therapies. Prescription digital
- [Aimed Alliance joins 31 Organizations and Patient Advocacy Groups in Applauding Congress for Introducing Legislation That Would Expand Access to Prescription Digital Therapies.](https://aimedalliance.org/aimed-alliance-joins-31-organizations-and-patient-advocacy-groups-in-applauding-congress-for-introducing-legislation-that-would-expand-access-to-prescription-digital-therapies/) - On March 25, 2022, Aimed Alliance and 31 other not-for-profit organizations and patient-advocacy groups sent a letter to Senators Shaheen and Capito and Representatives Thompson and McKinley supporting their introduction of Access to Prescription Digital Therapeutics Act of 2022 (H.R. 7051 and S.3791). Prescription Digital Therapies (PDTs) are prescription-only software that are regulated by the
- [Federal Government Facilitates Access To Prescription Digital Behavioral Therapies](https://aimedalliance.org/federal-government-facilitates-access-to-prescription-digital-behavioral-therapies/) - WASHINGTON, March 23, 2022 /PRNewswire/ -- Today, Aimed Alliance, the Center for U.S. Policy and the International Health Facility Diversion Association commended the federal government for facilitating patient access to prescription digital behavioral therapies. The Centers for Medicare & Medicaid Services (CMS) will establish a new medical code, effective April 1, 2022. The new Healthcare Common Procedure Coding System
- [Aimed Alliance Submits Letter of Support for Kentucky Step-Therapy Reform ](https://aimedalliance.org/aimed-alliance-submits-letter-of-support-for-kentucky-step-therapy-reform/) - On March 1, 2022, Aimed Alliance sent a letter to members of the Kentucky House Standing Committee on Banking and Insurance urging them to pass SB 140, which would enhance Kentucky’s current step-therapy law. Step-therapy, also known as fail-first, requires patients to try and fail on medications before their health plan will cover the medication
- [Upcoming Webinar -- Copay Accumulators 101 – Everything You Need to Know for Effective Patient Advocacy](https://aimedalliance.org/upcoming-webinar-copay-accumulators-101-everything-you-need-to-know-for-effective-patient-advocacy/) - Join Aimed Alliance for a FREE webinar on February 9, 2022 at 1:00PM ET - 2:00PM ET. You are invited to attend Copay Accumulators 101 – Everything You Need To Know For Effective Patient Advocacy, an online discussion on copay accumulators specifically for patient advocacy groups. When patients cannot afford their medications, they may rely on financial
- [Upcoming Webinar -- Covering Prescription Digital Therapeutics: A Win-Win for Employers and Employees](https://aimedalliance.org/covering-prescription-digital-therapeutics-a-win-win-for-employers-and-employees/) - Join Aimed Alliance for a FREE webinar on March 29, 2022 at 2:00PM ET - 3:00PM ET. In the United States approximately 49% of individuals gain health insurance through their employer sponsored health plan. Thus, employers play a crucial role in ensuring that individuals have access to comprehensive coverage and treatment for chronic diseases. Providing
- [Aimed Alliance Hosts Webinar on Copay Accumulators 101](https://aimedalliance.org/aimed-alliance-hosts-webinar-on-copay-accumulators-101/) - On February 9, 2022, Aimed Alliance hosted a webinar titled "Copay Accumulators 101: Everything You Need to Know For Effective Patient Advocacy.” View the webinar below. https://www.youtube.com/watch?v=yNAQDGfdzUY
- [Aimed Alliance Releases Know Your Rights Resource For Patients With Cardiovascular Diseases](https://aimedalliance.org/aimed-alliance-issues-new-know-your-rights-resource-for-patients-with-cardiovascular-diseases/) - On February 10, 2022, Aimed Alliance released a new Know Your Rights brochure for patients living with cardiovascular disease. The brochure provides an overview of coronary heart disease, cerebrovascular disease, and peripheral artery disease. In addition, the resource provides examples of health insurers’ benefit utilization practices, and information for patients on how to appeal a
- [Aimed Alliance Launches Copay Accumulator 101 Hub](https://aimedalliance.org/aimed-alliance-launches-copay-accumulator-101-hub/) - On February 9, 2022, Aimed Alliance announced it was launching a Copay Accumulator 101 Hub. When patients cannot afford their medications, they may rely on financial assistance, often called copay assistance, from pharmaceutical manufacturers and other third parties to meet their health plans’ cost-sharing responsibilities in order to fill their prescriptions. Typically, copay assistance can
- [Congress Continues to Discuss Temporary and Permanent Telehealth Expansion](https://aimedalliance.org/congress-continues-to-discuss-temporary-and-permanent-telehealth-expansion/) - Support for telehealth expansion is growing both on and off the Hill, but members of Congress disagree on whether this expansion should be temporary or permanent. In December 2021, Rep. Lloyd Doggett (D-TX) introduced the “Telehealth Extension Act,” which features a mix of both permanent expansions and temporary extensions. Among the many provisions, Doggett’s bill
- [Center for U.S. Policy Provides Recommendations to ISUDCC on Improving Federal Coordination of Substance Use Disorder Treatment](https://aimedalliance.org/center-for-u-s-policy-provides-recommendations-to-isudcc-on-improving-federal-coordination-of-substance-use-disorder-treatment/) - On December 9, 2021, ACTION for PDTs’ stakeholder group member, the Center for U.S. Policy (CUSP), presented at the Interdepartmental Substance Use Disorders Coordinating Committee (ISUDCC) meeting. CUSP provided recommendations for improving the federal coordination of substance use disorder (SUD) prevention, intervention, treatment, harm reduction, and recovery support programs and services. Among the many recommendations, CUSP encouraged the ISUDCC to expand Medicare and Medicaid benefits to cover prescription digital therapeutics (PDTs). CUSP explained that PDTs are evidence-based
- [Aimed Alliance Releases New Fact Sheet on IRS’s 2004 Notice and Copay Accumulator Reform](https://aimedalliance.org/aimed-alliance-releases-new-fact-sheet-on-irss-2004-notice-and-copay-accumulator-reform/) - Aimed Alliance has published a new fact sheet titled IRS’s 2004 Notice Should Not Prevent Copay Accumulator Reform. The fact sheet reviews how copay accumulator programs operate and the recent confusion surrounding the Internal Revenue Service (IRS) interpretation of its 2004 notice. The 2004 IRS Notice stated that individuals who have health savings account (HSA) for high deductible
- [Aimed Alliance Releases Oral Parity Fact Sheet](https://aimedalliance.org/aimed-alliance-releases-oral-parity-fact-sheet/) - On January 31, 2022, Aimed Alliance released a new fact sheet titled Patients with Cancer Must Be Able to Access the Chemotherapy Treatment That is Right for Them. This fact sheet provides an overview of cancer diagnosis in the United States and typical treatments . Although treatments may vary between patients, most treatments typically require
- [Aimed Alliance Launches New Telehealth Priorities Webpage](https://aimedalliance.org/aimed-alliance-launches-new-telehealth-priorities-webpage/) - The COVID-19 pandemic demonstrated how the use of technology can help ensure that patients have access to the care they need when they need it. In recognizing that technology in healthcare, and specifically, telehealth, will be part of the health system’s future, Aimed Alliance is excited to announce that it has developed a new page
- [Aimed Alliance Comments on 2023 NBPP](https://aimedalliance.org/aimed-alliance-comments-on-2023-nbpp/) - On January 27, 2022, Aimed Alliance submitted a comment to the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) on the 2023 HHS Notice of Benefit and Payment Parameters for 2023 (NBPP). Aimed Alliance supported HHS clarifying the following: discrimination based on sex includes discrimination based on
- [Aimed Alliance Quoted in Recent Los Angeles Times Article](https://aimedalliance.org/aimed-alliance-quoted-in-recent-los-angeles-times-article/) - On January 19, 2022, Aimed Alliance staff attorney Ashira Vantrees was quoted in the Los Angeles Times article Your health insurance says, ‘Claim denied.’ How to fight back by Jessica Roy. The article focuses on how consumers can challenge their health plan’s denial of coverage and advocate for their plan to reverse the decision. In
- [Aimed Alliance Release Know Your Rights for Patients with Depression](https://aimedalliance.org/aimed-alliance-release-know-your-rights-for-patients-with-depression/) - On January 31, 2022, in partnership with the Alliance for Mental Health Care Access (AMHCA), Aimed Alliance released a new Know Your Rights brochure for patients living with depression. The brochure provides an overview of the different types of depression such as persistent depressive disorder, postpartum depression, psychotic depression, seasonal affective disorder, and bipolar depression.
- [Share Your Experience: Treatment Access & Your Mental Health Care](https://aimedalliance.org/share-your-experience-treatment-access-your-mental-health-care-mental-health-survey/) - Alliance for Mental Health Care Access Survey The Alliance for Mental Health Care Access (AMHCA) is excited to share a new patient and provider survey on experiences with non-medical switching in mental health. Patients with mental health conditions rely on stable insurance coverage to access prescribed medications. Unfortunately, health plans and pharmacy benefit managers (PBMs) have taken
- [Lack of Health Plan Coverage Leads to Diminished Access to Treatments for Patients](https://aimedalliance.org/lack-of-health-plan-coverage-leads-to-diminished-access-to-treatments-for-patients/) - Prescription digital therapeutics (PDTs) are evidence-based medical interventions using software that can be accessed on a tablet or smartphone to prevent, manage, or treat a range of diseases and disorders. However, despite their medical benefits and convenience for patients, PDTs are not yet widely covered as a pharmacy benefit. A recent article in Politico Pro
- [New York Governor Signs Law Requiring PBM Transparency](https://aimedalliance.org/new-york-governor-signs-law-requiring-pbm-transparency/) - On December 31, 2021, New York Governor Kathy Hochul signed S.3672/A.1396 which will require pharmacy benefit managers (PBMs) to be licensed and registered in New York. The bill also imposes certain duties and obligations on PBMs and provides the Department of Financial Services with enforcement authority. PBMs are middlemen who negotiate with pharmaceutical manufacturers to
- [California Expands Access to Contingency Management Treatment for Substance Use Disorders](https://aimedalliance.org/california-expands-access-to-contingency-management-treatment-for-substance-use-disorders/) - On December 29, 2021, the California Department of Health Care Services (DHCS) announced that a California State’s Medicaid (Medi-Cal) pilot program had been approved by the Centers for Medicare and Medicaid Services (CMS). The pilot program titled California Advancing, and Innovating Medi-Cal (CalAIM) aims to make the Medi-Cal program more equitable, coordinated, and person-centered through
- [CMS Prohibits Georgia from Imposing Medicaid Work Requirements](https://aimedalliance.org/cms-prohibits-georgia-from-imposing-medicaid-work-requirements/) - On December 23, 2021, the Centers for Medicare and Medicaid Services (CMS) sent a letter to Georgian officials informing them that CMS was rescinding the state’s work requirement for Medicaid eligibility. During the previous administration the Department of Health and Human Services approved demonstration programs which allowed state-based Medicaid programs to condition Medicaid eligibility and
- [Wyden and Crapo Respond to Submissions on Improving Mental Health Care Access](https://aimedalliance.org/wyden-and-crapo-respond-to-submissions-on-improving-mental-health-care-access/) - On September 21, 2021, Senators Wyden and Crapo asked interested stakeholders to submit comments on evidence-based solutions and ideas to improving mental and behavioral health care access relating to strengthening the workforce; increasing integration, coordination, and access to care; ensuring parity between behavioral and physical health care; furthering the use of telehealth; and improving access to behavioral
- [Were Audio-Only Health Visits During the COVID-19 Pandemic Necessary to Ensure Access?](https://aimedalliance.org/were-audio-only-health-visits-during-the-covid-19-pandemic-necessary-to-ensure-access/) - During the COVID-19 pandemic, providers were granted a number of flexibilities and coverage expansions to ensure patients had access to care without increasing their COVID-19 exposure risk. One of the flexibilities granted was coverage of audio-only telehealth visits. Now, as the conversation moves toward what pandemic telehealth expansions should be kept and what should be tossed, a
- [Partnership to Advance Cardiovascular Health Sends Letter Urging CVS to Reverse Decision that Could Cause Non-Medical Switching](https://aimedalliance.org/partnership-to-advance-cardiovascular-health-send-letter-urging-cvs-to-reverse-decision-that-could-result-in-patients-being-non-medically-switched/) - On December 16, 2021, the Partnership to Advance Cardiovascular Health (PACH) sent a letter urging CVS Caremark to reverse its decision to limit coverage of certain anticoagulant medications. CVS Caremark recently sent a letter to patients informing them that as of January 1, 2022, it would only cover one direct oral anticoagulant from its commercial
- [The Role of Healthcare Professionals in Accessing Prescription Digital Therapeutics](https://aimedalliance.org/the-role-of-healthcare-professionals-in-accessing-prescription-digital-therapeutics/) - Prescription digital therapeutics (PDTs) are evidence-based medical interventions that use software accessed on a tablet or smartphone to prevent, manage, or treat a range of diseases and disorders. PDTs can allow patients to receive high-quality care without being required to travel to a healthcare facility. Cleared by the Food and Drug Administration (FDA) as medical devices, PDTs require a
- [Aimed Alliance Comments on Build Back Better and Future Healthcare Reform  ](https://aimedalliance.org/aimed-alliance-comments-on-build-back-better-and-future-healthcare-reform  /) - On November 26, 2021, Aimed Alliance sent a letter to U.S. Senators Carper, Coons, Cortez, Masto, Menendez, Murray, Sinema, Schumer and Wyden on the Build Back Better Act. The letter encouraged Senators to retain many of the provisions from the House of Representatives bill that expanded access to healthcare, such as extending postpartum coverage for women 12 months post-pregnancy; providing coverage to inmates 30 days prior to release; placing
- [RealClear Health Article Explains EHB Loophole and How the HELP Copays Act Can Fix It](https://aimedalliance.org/realclear-health-article-explains-the-ehb-loophole-and-how-the-help-copays-act-can-fix-it/) - RealClear Health recently published an article by Peter J. Pitts titled Just How ‘Essential Are Your Health Benefits.’ The article explains that under the Patient Protection and Affordable Care Act (ACA) health plans are required to cover a set of 10 Essential Health Benefits (EHB), including prescription drugs. However, the author explains that some plans
- [Real Clear Health Publishes Aimed Alliance Op-Ed on Non-Medical Switching and Patients with Mental Health Conditions](https://aimedalliance.org/real-clear-health-publishes-aimed-alliance-op-ed-on-non-medical-switching-and-patients-with-mental-health-conditions/) - On December 15, 2021, RealClear Health published Aimed Alliance’s article on non-medical switching titled Improving America’s Mental Health Starts with Consistent Treatment Access The article addresses how health plans can change their treatment coverage mid-year and force patients with mental health conditions to switch medications for non-medical reasons. This practice is known as non-medical switching, and can force stable patients
- [Supreme Court Hears Oral Arguments on 340B Hospital Discount Lawsuit](https://aimedalliance.org/supreme-court-hears-oral-arguments-on-340b-hospital-discount-lawsuit/) - On November 30, 2021, the Supreme Court of the United States heard oral arguments from the American Hospital Association (AHA) and the Department of Health and Human Services (HHS) on whether the Centers for Medicare and Medicaid Services (CMS) could reimburse drugs that were distributed through the 340B program at a lower rate than non-340B
- [Survey Finds that One in Four Health Plans is Using a Copay Accumulator Program](https://aimedalliance.org/survey-finds-that-one-in-four-health-plans-is-using-a-copay-accumulator-program/) - When patients cannot afford their medications, they may receive copay assistance from a pharmaceutical manufacturer or another third-party. Generally, the third-party contributions count towards the individual’s deductible and annual out-of-pocket. However, some plans have implemented copay accumulator programs which prohibit the cost of the third-party assistance from contributing towards the individual’s deductible and annual out-of-pocket
- [Coalition Encourages Treasury and IRS To Expand HSA Pre-Deductible Services to Include Mental Health and Substance Use Disorder Services](https://aimedalliance.org/coalition-encourages-treasury-and-irs-to-expand-hsa-pre-deductible-services-to-include-mental-health-and-substance-use-disorder-services/) - In November 2021, the Smarter Health Care Coalition (SHCC) sent a letter to the Department of the Treasury and the Internal Revenue Service (IRS) calling for the expansion ofthe definition of preventative services to include treatments for mental health and substance use disorders. Generally, high-deductible health plans that are linked to health savings accounts (HDHP-HSA) are prohibited
- [Aimed Alliance Sends Letter Supporting the Utah All Copays Count Coalition](https://aimedalliance.org/aimed-alliance-sends-letter-supporting-the-utah-all-copays-count-coalition/) - On November 29, 2021, Aimed Alliance sent a letter to the Utah All Copays Count Coalition supporting their efforts to enact copay accumulator reform. When patients cannot afford their medications, they may rely on financial assistance from pharmaceutical manufacturers and other third parties to meet their health plan’s cost-sharing responsibilities. The value of this third-party assistance should
- [Aimed Alliance Releases Executive Summary of ACTION for PDT Webinar](https://aimedalliance.org/aimed-alliance-releases-executive-summary-of-action-for-pdt-webinar/) - On November 22, 2021, ACTION for PDTs hosted its first webinar Addressing Chronic Diseases, Mental Health, and Substance Use in America: Optimizing Care with Prescription Digital Therapeutics (PDTs). ACTION for PDTs is a multidisciplinary partnership that is working to expand the adoption, coverage and access to PDTs for individuals living with chronic diseases. The webinar reviewed (1) how
- [Aimed Alliance Submits Comment on HCPCS Codes for PDTs and Releases New HCPCS Fact Sheet](https://aimedalliance.org/aimed-alliance-submits-comment-on-hcpcs-codes-for-pdts-and-releases-new-hcpcs-fact-sheet/) - On December 2, 2021, Aimed Alliance submitted a comment to the Centers for Medicare and Medicaid Services (CMS) urging them to create a HCPCS code for prescription digital therapeutics (PDTs) to expand patient access to these therapeutics. Our comment recognized that while some medical devices may qualify to use HCPCS Level 1 codes, also known as Current
- [Misleading Marketing Tactics Results in Consumers Being Steered Away from the Federal Marketplace](https://aimedalliance.org/misleading-marketing-tactics-results-in-consumers-being-steered-away-from-the-federal-marketplace/) - A 2021 study by Georgetown University Health Policy Institute Center found that during the COVID-19 special enrollment period online enrollment resources and marketers mislead consumers about health insurance plans and more often attempted to direct them to non-Patient Protection and Affordable Care Act (ACA) plans. The study developed two “secret shopper” profiles to determine how
- [Medicare Part B Premiums Increases Could Impact Patient Access](https://aimedalliance.org/medicare-part-b-premiums-increases-could-impact-patient-access/) - On November 12, 2021, the Centers for Medicare and Medicaid Services (CMS) announced that premiums for Medicare Part B would increase by 5.6%, the largest increase in thirty-years. Medicare Part B covers both preventative and medically necessary services for individuals over the age of 65, people with disabilities, or those with End-Stage-Renal-Disease. Preventative and medically
- [AMHCA Submits Letter to Senators Wyden and Crapo on Improving Mental and Behavioral Health Access for Patients](https://aimedalliance.org/amhca-submits-letter-to-senators-wyden-and-crapo-on-improving-mental-and-behavioral-health-access-for-patients/) - On November 1, 2021, the Alliance for Mental Healthcare Access (AMHCA) submitted a letter to Senator Ron Wyden and Senator Mike Crapo of the United States Senate Finance Committee on expanding access to mental and behavioral health services. Our letter thanked the Senators for their work in addressing issues related to mental and behavioral health
- [Yahoo Finance Data Shows that Inflation Is Occurring in All Industries Except Prescription Drugs](https://aimedalliance.org/yahoo-finance-data-shows-that-inflation-is-occurring-in-all-industries-except-prescription-drugs/) - A frequent criticism in the healthcare accessibility discussion is prescription drug pricing in the United States, and often the claim that prescription drug pricing is outpacing the cost of inflation. However, a recent Yahoo!News article found that while certain markets in the United States are seeing increased inflation, such as rental cars and gasoline, others such as prescription drug prices are not. The article specifically found that prescription
- [Survey Finds Lack of Knowledge and Coverage of Prescription Digital Therapeutics Among Payers](https://aimedalliance.org/survey-finds-lack-of-knowledge-and-coverage-of-prescription-digital-therapeutics-among-payers/) - A recent article by HealthPayer Intelligence found that only 40 of 180 insurance companies surveyed were familiar with prescription digital therapeutics (PDTs). Further, the survey found that of the 40 insurers that were familiar with PDTs, only 4 out of 10 covered PDTs as a benefit. Thus, out of 180 payers, only 16 were covering PDTs. The survey also found that insurers were interested in beginning to cover PDTs because PDTs are
- [COVID-19 Hospital Funding Helped to Alleviate Some Racial Disparities But Not Others](https://aimedalliance.org/covid-19-hospital-funding-helped-to-alleviate-some-racial-disparities-but-not-others/) - The pandemic has highlighted racial disparities, with rates of severe illness and death resulting from COVID-19 disproportionately higher among people of color. A recent Health Affairs study explored how federal COVID-19 hospital funding was being distributed to determine whether inequities were being addressed. The study found that hospitals serving a higher share of Black patients received increased funding. However, hospitals with a higher share of Hispanic patients received less funding. The researchers elaborated that
- [Join Aimed Alliance for a Webinar on Addressing Chronic Diseases, Mental Health, and Substance Use In America: Optimizing Care with Prescription Digital Therapeutics](https://aimedalliance.org/join-aimed-alliance-for-a-webinar-on-addressing-chronic-diseases-mental-health-and-substance-use-in-america-optimizing-care-with-prescription-digital-therapeutics/) - Join Aimed Alliance for a FREE webinar on November 22, 2021 at 1:00PM ET - 2:00PM ET. You are invited to attend Addressing Chronic Diseases, Mental Health, and Substance Use in America, an online expert roundtable on the emergence of a new category to medicine – prescription digital therapies (PDTs). PDTs use software on smart
- [Prescription Digital Therapeutics as an Emerging Healthcare Frontier](https://aimedalliance.org/prescription-digital-therapeutics-as-an-emerging-healthcare-frontier/) - Recently, the Alliance for Patient Access (AfPA) published a blog titled Prescription Digital Therapeutics Emerge as Health Care’s Newest Frontier. The blog highlights how prescription digital therapeutics (PDTs) work and their potentially uncertain path ahead. Specifically, the blog explains that PDTs are therapeutics that are prescribed by providers as a form of treatment for a wide variety of conditions such as chronic insomnia, diabetes,
- [ACTION for PDTs Releases Two New Resources on Prescription Digital Therapeutics](https://aimedalliance.org/action-for-pdts-releases-two-new-resources-on-prescription-digital-therapeutics/) - On October 28, 2021, Aimed Alliance’s multidisciplinary stakeholder group, ACTION for PDTs in collaboration with the ACTION for PDTs’ California Working Group, released two new California-focused resources on prescription digital therapeutics (PDTs): Prescription Digital Therapeutics: Introducing Software as Medicine and Prescription Digital Therapeutics: Fact Sheet. ACTION for PDTs, is a multi-disciplinary partnership that works to expand the adoption of, coverage of, and access to PDTs for individuals with chronic diseases. The first
- [Governor Newsom Vetoes SB 110 Denying Contingency Management Coverage But Approves a Pilot Program](https://aimedalliance.org/governor-newsom-vetoes-sb-110-denying-contingency-management-coverage-but-approves-a-pilot-program/) - On October 8, 2021, California Governor Gavin Newsom announced that he would be vetoing SB 110. SB 110 would have allowed the California state Medicaid program, Medi-Cal, to provide contingency management as a covered benefit for treating substance use disorders (SUDs). Prescription digital therapeutics (PDTs) deliver contingency management treatment. PDTs are evidence-based medical interventions that use software that can be accessed on a tablet or smartphone to
- [Massachusetts Becomes the First State to Offer Coverage for Prescription Digital Therapeutics](https://aimedalliance.org/massachusetts-becomes-the-first-state-to-offer-coverage-for-prescription-digital-therapeutics/) - The Massachusetts Medicaid and Children’s Health Insurance Program, known as MassHealth, announced that effective November 1, 2021, MassHealth would begin covering prescription digital therapeutics (PDTs). PDTs are considered a new category of therapeutics that are evidence-based medical interventions using software that can be accessed on a tablet or smartphone to prevent, manage, or treat a range of diseases
- [California v. Texas](https://aimedalliance.org/texas-v-azar/) - Brief Summary: This case challenges the constitutionality of the Patient Protection and Affordable Care Act (ACA) as a whole. Overview: The ACA contains a provision that requires everyone to maintain a minimum level of health insurance or pay a tax penalty, commonly referred to as the individual mandate. The constitutionality of this provision has long
- [Association for Community Affiliated Plans v. U.S. Department of Treasury](https://aimedalliance.org/association-for-community-affiliated-plans-v-united-states-department-of-treasury/) - Brief Summary: This case challenges a rule issued by the U.S. Department of Health and Human Services (HHS), the U.S. Department of Labor (DOL), and the U.S. Department of Treasury (Treasury), which expanded the maximum length of short-term, limited-duration insurance (STLDI) plans. The plaintiffs claim that this expansion violates the Patient Protection and Affordable Care
- [Aimed Alliance Submits Comment on Most Favored Nation Rule Revocation](https://aimedalliance.org/aimed-alliance-submits-comment-on-most-favored-nation-rule-revocation/) - On October 12, 2021, Aimed Alliance submitted a comment to the Centers for Medicare & Medicaid Services (CMS) on its proposed rule that would revoke the November 27, 2020 Most Favored Nation (MFN) Model Rule. The MFN Model Rule would have placed price caps on 50 Medicare Part B prescription drugs. The price caps for these drugs would have been based on the lowest price that drug manufacturers receive
- [SB 110 Would Allow the California state Medicaid Program to Cover Contingency Management for Treating Substance Use Disorders](https://aimedalliance.org/sb-110-would-allow-the-california-state-medicaid-program-to-cover-contingency-management-for-treating-substance-use-disorders/) - On September 7, 2021, the California legislature passed SB-110. SB-110 would allow the California state Medicaid program, Medi-Cal, to provide contingency management as a covered benefit for treating substance use disorders. Contingency management is a behavioral treatment that rewards patients’ positive behaviors. This can be an effective treatment for patients with substance use disorders (SUDs). For example, one study by the San Francisco AIDS found that 47% of participants in a contingency management program were confident in their ability to stop using methamphetamine entirely upon
- [Patient Access Collaborative Releases Advocacy Insights on Prior Authorization](https://aimedalliance.org/patient-access-collaborative-releases-advocacy-insights-on-prior-authorization/) - Recently, Emma Watson, MPH with the American Cancer Society Cancer Action Network spoke to the Patient Access Collaborative (PAC) on the impact prior authorization policies have on cancer patients. Prior authorization policies require a health care provider or an insurance plan enrollee to obtain approval from the insurer or its pharmacy benefit manager before the plan will cover the cost of a health care product or
- [Kentucky, New Mexico, and Maine Now Running State-Based Health Marketplaces](https://aimedalliance.org/kentucky-new-mexico-and-maine-now-running-state-based-health-marketplaces/) - On October 4, 2021, the Governors of Kentucky, New Mexico, and Maine announced they had transitioned from the federal health care marketplace exchange to individual state-based health care marketplace exchanges. By developing state-based health care marketplaces, these states can benefit from subsidies created in the Patient Protection and Affordable Care Act (ACA), while also expanding coverage and providing additional state-based subsidies to state residents. The New Mexico marketplace opened for plan viewing on October 1, 2021, while Maine and Kentucky Marketplaces open for
- [HHS Releases New Interim Rule for Dispute Resolution of Surprise Medical Bills  ](https://aimedalliance.org/hhs-releases-new-interim-rule-for-dispute-resolution-of-surprise-medical-bills/) - On September 30, 2021, the Department of Health and Human Services (HHS), the Department of Labor (DOL), the Department of Treasury, and the Office of Personnel Management issued an interim final rule on an independent dispute resolution mechanism under the No Surprises Act. The Interim Rule provides that health plans and out-of-network providers have 30-days to negotiate the cost of an item
- [A Health Insurance Practice that Could Fuel the Mental Health Crisis](https://aimedalliance.org/health-insurance-practices-that-could-fuel-the-mental-health-crisis/) - A recent Modern Healthcare article by Dr. Rimal Bera addresses how health insurance practices could be fueling the mental health crisis in the United States. Dr. Bera’s article explains how non-medical switching drives stable patients from their current medication to one that is more profitable for the health plan. Health insurers can impose nonmedical switching
- [Alliance for Mental Health Care Access Hosts First Roundtable Meeting](https://aimedalliance.org/alliance-for-mental-health-care-access-hosts-first-roundtable-meeting/) - On August 31, 2021, the Alliance for Mental Health Care Access (“AMHCA”) conducted its first roundtable meeting. AMHCA is a new working group that is expanding on the work of the Alliance for Depression Care Access (“ADCA”). Co-led by Aimed Alliance and the Alliance for Patient Access (“AfPA”), AMHCA works to prevent the non-medical switching
- [HHS Interim Final Rule on Surprise Billing Goes Into Effect](https://aimedalliance.org/hhs-interim-final-rule-on-surprise-billing-goes-into-effect/) - On September 13, 2021, the Department of Health and Human Services (“HHS”) Interim Final Rule on the No Surprises Act went into effect. Surprise medical bills arise when patients visit a hospital or health care provider that they think is in their insurance network, but are then treated by a doctor, specialist, technician, or other health care provider who is out-of-network. The patient
- [Telehealth in a Post-Pandemic World](https://aimedalliance.org/telehealth-in-a-post-pandemic-world/) - On August 3, 2021, Aimed Alliance hosted a virtual policy briefing for patient advocacy groups and professional associations titled “Telehealth in a Post-Pandemic World: Preserving Gains and Ensuring Access to In-Person Care.” The event included an overview of how telehealth access has changed over the course of the pandemic; an update on policies being considered by CMS and Congress; the perspectives
- [North Carolina Legislature Passes New Copay Accumulator Bill](https://aimedalliance.org/north-carolina-legislature-passes-new-copay-accumulator-bill/) - On September 9, 2021, the North Carolina General Assembly passed Senate Bill 257. This bill provides consumer protections against copay accumulator programs. Recently increasing in prevalence, copay accumulator programs prevent the value of a drug manufacturer’s financial assistance from counting toward a patient’s deductible and maximum out-of-pocket limit, which can have a significant financial impact on patients. Copay accumulator programs
- [Aimed Alliance Releases Updated Open Enrollment Brochures](https://aimedalliance.org/aimed-alliance-releases-updated-open-enrollment-brochures/) - The open enrollment periods for individual, small, large group, and Medicare plans are rapidly approaching. To ensure consumers are able to select the plan that is most appropriate for their needs, we have updated our various brochures, including the following: “Open Enrollment: Understanding Your Health Plan and Your Cost-Sharing Responsibilities” – This brochure is most suitable for individuals
- [Aimed Alliance Submits Comment on the Cannabis Administration and Opportunity Act](https://aimedalliance.org/aimed-alliance-submits-comment-on-the-cannabis-administration-and-opportunity-act/) - On September 1, 2021, Aimed Alliance submitted a comment to Senators Schumer, Wyden, and Booker on the Discussion Draft: Cannabis Administration and Opportunity Act (CAOA). The CAOA would remove cannabidiol from the Controlled Substances Act and transfer jurisdiction over cannabidiol products to the Bureau of Alcohol, Tobacco and Firearms (ATF), the Tobacco Tax and Trade Bureau (TTB), and the U.S. Food and Drug Administration (FDA). The CAOA would also reinvest in communities that have been most impacted by cannabis criminalization; create a
- [Study Finds Patients Spent $35.8 Billion Due to Payers’ Benefit Utilization Management Techniques](https://aimedalliance.org/study-finds-patients-spent-35-8-billion-due-to-payers-benefit-utilization-management-techniques/) - A recent study in Health Affairs found that payers, pharmaceutical manufactures, health care providers, and patients incur approximately $93.3 billion in annual costs on implementing, contesting, and navigating drug utilization management programs. Drug utilization management is a collection of cost reduction techniques and programs used by health insurers. They often involve restricting access to medications (e.g., prior authorization and step therapy) or shifting cost-sharing burdens
- [New Video – CVS: Don’t Leave Depression Patients in the Dark](https://aimedalliance.org/new-video-cvs-dont-leave-depression-patients-in-the-dark/) - In 2021, CVS Caremark intends to exclude coverage of four antidepressants known as selective serotonin reuptake inhibitors (SSRIs) from its formularies. The effects of a CVS formulary change could be dire and life-threatening for depression patients who could lose access to their SSRI treatment. It could even put patients at increased risk of suicide –
- [RealClearHealth Publishes Aimed Alliance Op-Ed on CVS Caremark Formulary Changes](https://aimedalliance.org/realclearhealth-publishes-aimed-alliance-op-ed-on-cvs-caremark-formulary-changes/) - On December 24, 2020, RealClearHealth published an op-ed by Aimed Alliance counsel Stacey Worthy. The op-ed discusses CVS Caremark’s proposed formulary changes, which includes eliminating coverage for certain selective serotonin reuptake inhibitors (SSRIs) used to treat depression at the beginning of the new year. This change would force patients to switch their treatments and leave
- [Aimed Alliance Raising Issues with BSBC of Alabama’s Prior Authorization Policy for Treatment of Degenerative Eye Diseases](https://aimedalliance.org/aimed-alliance-raising-issues-with-bsbc-of-alabamas-prior-authorization-policy-for-treatment-of-degenerative-eye-diseases/) - On July 2, 2021, Aimed Alliance sent a letter to Blue Cross Blue Shield of Alabama (BCBS AL) in response to a new prior authorization policy, effective July 1, 2021, for a medication to treat degenerative eye diseases.[1] The policy requires patients with neovascular (wet) age-related macular degeneration (Wet AMD), macular edema following retinal vein
- [Aimed Alliance Reiterates Concerns to Cigna about $500 Debit Card Program](https://aimedalliance.org/aimed-alliance-reiterates-concerns-to-cigna-about-500-debit-card-program/) - On May 14, 2021, Aimed Alliance initially sent a letter to Cigna to express our concerns about the insurer’s recent decision to offer $500 debit cards to patients if they switch from a medication for psoriasis and psoriasis arthritis to another for nonmedical reasons.[1] Since then, we learned that Cigna has adopted the same program
- [Aimed Alliance Calls on Federal Agencies to Take Action on Copay Accumulator Programs](https://aimedalliance.org/aimed-alliance-calls-on-federal-agencies-to-take-action-on-copay-accumulator-programs/) - On Jul 23, 2021, Aimed Alliance submitted a comment in response to the “Request for Information Regarding Reporting on Pharmacy Benefits and Prescription Drug Costs” (RFI). In the RFI, the U.S. Departments of the Treasury, Labor, and Health and Human Services (“Departments”) proposed that health plans report rebates, fees, and any other remuneration paid by
- [Aimed Alliance Sends Letter to BCBS Excellus to Request Improved Access for Lung Cancer Therapy](https://aimedalliance.org/aimed-alliance-sends-letter-to-bcbs-excellus-to-request-improved-access-for-lung-cancer-therapy/) - Aimed Alliance and three other patient advocacy groups sent a letter to Excellus BCBS, a New York insurer, expressing our concerns over its prior authorization and step therapy policy for non-small cell lung cancer (NSCLC) treatments, which it adopted midyear. The new policy effectively excludes at least one medication from coverage. Patients with advanced NSCLC
- [Aimed Alliance Releases 2020 Annual Report](https://aimedalliance.org/aimed-alliance-releases-2020-annual-report/) - In 2020, Aimed Alliance engaged in a wide array of activities to protect and enhance the rights of health care consumers and providers despite of and in response to the COVID-19 pandemic. We are pleased to share our progress with you. In our 2020 Annual Report, you can review the projects we completed over the
- [New Aimed Alliance Publication: Health Coverage of Certain Cannabis Products Poses Risks to Employers & Employees Alike](https://aimedalliance.org/health-coverage-of-non-fda-approved-cannabis-products/) - Policymakers Should Oppose Efforts to Mandate Coverage of Non-FDA-Approved Cannabis Products that Conflict with Federal Laws & Increase Risk of Employer Liability WASHINGTON, DC., JUNE 8, 2021 — Today, Aimed Alliance announced the release of Dazed and Confused: Making Sense of Employers' Risks from Mandated Coverage of Non-FDA-Approved Cannabis Products, a new publication featuring analysis
- [Connecticut Becomes Tenth State to Pass Copay Accumulator Program Reform](https://aimedalliance.org/connecticut-becomes-tenth-state-to-pass-copay-accumulator-program-reform/) - On June 2, 2021, Governor Ned Lamont signed SB 1003 into law, making Connecticut the tenth state to pass copay accumulator program reforms. The new law requires both health plans and pharmacy benefit managers to count third party payments toward the plan enrollee’s cost-sharing requirements. Read the bill here.
- [Nebraska Passes Step Therapy Law](https://aimedalliance.org/nebraska-passes-step-therapy-law/) - On March 31, 2020, Nebraska Governor Pete Ricketts signed LB337 into law, which strengthens protections for patients who are subject to step therapy by their insurer. The law limits health plans’ use of step therapy requirements in favor of patient access and individualized care. For example, the law requires health plans to use evidence-based and
- [Aimed Alliance Leads Efforts to Oppose Louisiana Bill that Permits Nonmedical Switching](https://aimedalliance.org/aimed-alliance-leads-efforts-to-oppose-louisiana-bill-that-permits-nonmedical-switching/) - On May 25, 2021, Aimed Alliance and 19 other patient advocacy groups and health professional organizations sent a letter to members of the Louisiana House of Representatives in opposition to SB 181, which would allow health plans to engage in nonmedical switching of stable patients. The bill allows plans to drop medications or increase out-of-pocket
- [Aimed Alliance Sends Letter to Cigna Expressing Concerns Over $500 Debit Card Program](https://aimedalliance.org/aimed-alliance-sends-letter-to-cigna-expressing-concerns-over-500-debit-card-program/) - On May 14, 2021, Aimed Alliance sent a letter to Cigna to express concerns over its $500 debit card program. Under the program, stable patients with psoriasis and psoriatic arthritis receive an inducement of $500 to switch from one biologic medication to another, a form of nonmedical switching. As we noted in our letter, the
- [Congress Can Lower Drug Prices by Following West Virginia’s Lead in Passing Rebates to Consumer](https://aimedalliance.org/congress-can-lower-drug-prices-by-following-west-virginias-lead-in-passing-rebates-to-consumer/) - A new op-ed by Dr. Chris Stansbury details a potential new approach for Congress in controlling prescription drug prices: regulating pharmacy benefits managers (PBMs). PBMs are middlemen in the pharmaceutical supply chain, originally created to assist manufacturers in getting their drug to consumers. However, PBMs often serve as a barrier to consumers receiving manufacturer rebates
- [Aimed Alliance Weighs in on Pennsylvania’s Step Therapy and Prior Authorization Bill](https://aimedalliance.org/aimed-alliance-weighs-in-on-pennsylvanias-step-therapy-and-prior-authorization-bill/) - On May 10, 2021, Aimed Alliance sent a letter to Pennsylvania legislators in support of HB 225 and SB 225. These bills would limit health plans’ use of step therapy and prior authorization requirements in favor of patient access and individualized care. For example, the bills prohibit health plans from imposing preauthorization requirements on treatment
- [Aimed Alliance Sends Letter in Support of New Jersey Step Therapy Reform](https://aimedalliance.org/aimed-alliance-sends-letter-in-support-of-new-jersey-step-therapy-reform/) - On May 7, 2021, Aimed Alliance sent a letter in support of New Jersey A4815, which would establish important patient protections for step therapy protocols. Some step therapy policies are inconsistent with sound scientific and clinical evidence. They can cause patients to experience harmful side effects, an interruption patient stability, and disease progression and relapse,
- [Aimed Alliance Releases New Fact Sheet on H.R. 3, Detailing Pros and Cons to Patient Welfare](https://aimedalliance.org/aimed-alliance-releases-new-fact-sheet-on-h-r-3-detailing-pros-and-cons-to-patient-welfare/) - Aimed Alliance has created a new fact sheet dedicated to H.R. 3, otherwise known as the Elijah E. Cummings Lower Drug Costs Now Act, a piece of pending legislation that could be included in the new federal infrastructure bill. The bill includes a variety of provisions aimed at lowering prescription drug prices and patient costs
- [Aimed Alliance Submits a Letter in Support of Connecticut Bill That Prohibits the Use of QALY as a Health Insurance Threshold](https://aimedalliance.org/aimed-alliance-submits-a-letter-in-support-of-connecticut-bill-that-prohibits-the-use-of-qaly-as-a-health-insurance-threshold/) - On May 4, 2021, Aimed Alliance submitted a letter in support of Connecticut HB 6242 to members of the Connecticut legislature. The bill would prohibit the use of dollars-per-quality adjusted life year (QALY) or similar measures to limit coverage or reimbursement in health plans. Insurers use QALYs to justify limitations on patient access to treatment,
- [CMS Lowers Out-of-Pocket Costs and Expands Special Enrollment Periods](https://aimedalliance.org/cms-lowers-out-of-pocket-costs-and-expands-special-enrollment-periods/) - On April 30, 2021, the Centers for Medicare and Medicaid Services (CMS) released the second part of the 2022 Notice of Benefit and Payment Parameters (NBPP) Final Rule. The new part of the rule includes several provisions to help consumers distinguish between plan options, qualify for additional special enrollment periods (SEPs), and reduce patients’ out-of-pocket
- [Patients Raise Concerns with New Cigna Policy that Pays Patients to Switch Meds](https://aimedalliance.org/patients-raise-concerns-with-new-cigna-policy-that-pays-patients-to-switch-meds/) - Patient groups and practitioners have raised concerns about a new Cigna policy that offers a $500 pre-paid medical debit card to patients if they switch from a biologic product for multiple rheumatic diseases to a Cigna-preferred drug. The policy follows Cigna’s removal of the drug from its preferred drug list and encourages patients to switch
- [New Fact Sheet: White Bagging and Brown Bagging Policies Explained](https://aimedalliance.org/new-fact-sheet-white-bagging-and-brown-bagging-policies-explained/) - Over the past few years, health insurers have increasingly begun adopting policies referred to as “white bagging” and “brown bagging,” which require patients with complex, chronic, or rare conditions to obtain certain treatments (i.e., specialty drugs) from specialty pharmacies. On April 28, 2021, Aimed Alliance released a new fact sheet titled “White Bagging and Brown
- [Join Aimed Alliance & SHRM for Webinar: Coverage of Marijuana as a Health Benefit: What Employers Need to Know](https://aimedalliance.org/join-aimed-alliance-shrm-for-webinar-coverage-of-marijuana-as-a-health-benefit-what-employers-need-to-know/) - Join Aimed Alliance for a FREE webinar on April 29, 2021 at 12:00pm ET. Join Aimed Alliance and the Society for Human Resource Management (SHRM) for a FREE webinar titled “Coverage of Marijuana as a Health Benefit: What Employers Need to Know” on Thursday, April 29, 2021 from 12:00 pm ET to 1:00 pm ET. This webinar
- [Oklahoma Governor Stitt Signs New Copay Accumulator Law](https://aimedalliance.org/oklahoma-governor-stitt-signs-new-copay-accumulator-law/) - On April 19, Oklahoma Governor Kevin Stitt signed HB 2678 into law. The new law prohibits the use of copay accumulator programs as an unfair claims settlement practice. Recently increasing in prevalence, copay accumulator programs prevent the value of a drug manufacturer’s financial assistance from counting toward a patient’s deductible and maximum out-of-pocket limit, which
- [Deloitte Finds Compliance with CMS Hospital Price Transparency Rule is Low Overall](https://aimedalliance.org/deloitte-finds-compliance-with-cms-hospital-price-transparency-rule-is-low-overall/) - Deloitte found that most hospitals have been slow to comply with the requirements of the CMS Hospital Price Transparency Rule’s that went into effect on January 1, 2021. The rule requires hospitals to provide a comprehensive file of all their items and services and a display with 300 shoppable services in a consumer-friendly format. Hospital
- [Federal and State Marketplace Exchanges Extend Special Enrollment Deadlines](https://aimedalliance.org/federal-and-state-marketplace-exchanges-extend-special-enrollment-deadlines/) - Following the enactment of the American Rescue Plan, the federal government and several states have extended special enrollment periods to allow consumers to take advantage of the increased Affordable Care Act tax credits available under the new law. The special enrollment period is open to new and current enrollees alike and the tax credits may
- [Kentucky Governor Beshear Signs New Copay Accumulator Law](https://aimedalliance.org/kentucky-governor-beshear-signs-new-copay-accumulator-law/) - On March 25, Kentucky Governor Andy Beshear signed SB45 into law. The new law limits how state-regulated insurers can implement copay accumulator programs. Such programs prevent the value of a drug manufacturer’s financial assistance from counting toward a patient’s deductible and maximum out-of-pocket limit. This can have a significant financial impact on patients, especially those
- [District Court Allows Georgia AG to Intervene in Lawsuit Challenging HHS Approval of State’s 1332 Waiver](https://aimedalliance.org/district-court-allows-georgia-ag-to-intervene-in-lawsuit-challenging-hhs-approval-of-state-1332-waiver/) - On March 26, the District Court for the District of Columbia ruled that Georgia can intervene in a lawsuit challenging the Department of Health and Human Services’ (HHS) decision to grant the state’s 1332 waiver. The waiver would allow Georgia to leave healthcare.gov and rely on agents and brokers to enroll consumers in Patient Protection
- [HHS Postpones SUNSET Rule Due to Significant Burden on FDA and CMS](https://aimedalliance.org/hhs-postpones-sunset-rule-due-to-significant-burden-on-fda-and-cms/) - On March 19, the Department of Health and Human Services (HHS) announced that it will postpone the effective date of a recently finalized rule, “Securing Updated and Necessary Statutory Evaluations Timely,” (SUNSET Rule) until March 22, 2022. The SUNSET Rule would have required HHS to assess and review most of its regulations every 10 years
- [CMS Reverses Recent Demonstration Plan That Would Have Allowed Part D Plans to Waive Protected Class and Formulary Requirements in 2022](https://aimedalliance.org/cms-reverses-recent-demonstration-plan-that-would-have-allowed-part-d-plans-to-waive-protected-class-and-formulary-requirements-in-2022/) - CMS announced updates to the Part D Payment Modernization Model Calendar Year 2022 (PDM Model), reversing changes that were implemented in the final days of the Trump Administration. The PDM Model would have removed important protections for drugs in the six protected classes, such as allowing plans that participate in the model to treat five
- [Aimed Alliance Launches New York Step Therapy Reform Initiative](https://aimedalliance.org/aimed-alliance-launches-new-york-step-therapy-reform-initiative/) - Building on the step therapy law that was effective as of 2017, Aimed Alliance has launched a new initiative to educate policy makers on the need for step therapy reform in New York. Step therapy policies, also referred to as “fail first,” require insured individuals to try and fail on alternative treatments before the insurer
- [Aimed Alliance Submits Letters to State Legislators Advocating for Bills Limiting Copay Accumulators](https://aimedalliance.org/aimed-alliance-submits-letters-to-state-legislators-advocating-for-bills-limiting-copay-accumulators/) - Aimed Alliance submitted letters to legislators advocating for limits on copay accumulator programs in 10 states: Maryland, New Mexico, Connecticut, Kentucky, New York, Nebraska, South Dakota, Oregon, Ohio, and Tennessee. These programs prevent third party assistance to patients, such as drug manufacturer’s coupons, from counting toward a patient’s deductible and maximum out-of-pocket limit. This can
- [CMS Starts Process to Rescind Medicaid Work Requirements](https://aimedalliance.org/cms-starts-process-to-rescind-medicaid-work-requirements/) - On February 12, 2021, The Centers for Medicare and Medicaid Services (CMS) notified states that it no longer believes work requirements are compatible with the goals of Medicaid and is giving states 30 days to argue in favor of keeping the programs. The work requirement demonstrations, created under the Trump administration, would allow states to
- [Biden Administration Asks Court to Pause Section 1557 Lawsuit](https://aimedalliance.org/biden-administration-asks-court-to-pause-section-1557-lawsuit/) - On February 10, 2021, the Department of Health and Human Services asked the Southern District of New York to pause the ongoing lawsuit arising from the previous administration’s Section 1557 rule. The rule, enacted by the Office for Civil Rights, rolls back healthcare protections for LGBTQ populations, reduces language requirements, and narrows the rule’s scope.
- [State of New York v. U.S. Department of Labor](https://aimedalliance.org/state-of-new-york-v-u-s-department-of-labor/) - Brief Summary: This case challenges the U.S. Department of Labor’s regulation that allows communities of interest to count as an employer as it is defined and governed by the Employer Retirement Income Security Act (ERISA). As an employer governed by ERISA, businesses may offer a single health plan, known as an association health plan, and
- [Aimed Alliance Migraine in the Workplace Survey Featured on MigraineAgain.com](https://aimedalliance.org/aimed-alliance-migraine-in-the-workplace-survey-featured-on-migraineagain/) - A new MigraineAgain post highlighting migraine disease at work as a women’s health issue features Aimed Alliance’s Counsel, Stacey Worthy, and her knowledge on navigating migraine disease in the workplace. Migraine disease disproportionately affects women, with women composing nearly 73 percent of the 40 million Americans who live with migraine disease. Over 85% of people
- [Payers Acknowledge Negative Impacts of Copay Accumulator Programs in New Survey from MME Advisors](https://aimedalliance.org/payers-acknowledge-negative-impacts-of-copay-accumulator-programs-in-new-survey-from-mme-advisors/) - Although payers argue copay accumulator programs are only intended to shift patients to less expensive generic alternatives, a new survey conducted by MME Advisors found that the majority of pharmacy and medical directors representing various health plans nationwide strongly agree that copay accumulator programs can shift costs from plan sponsors to patients. Most also agreed
- [Aimed Alliance Op-Ed Featured in HR.com’s Employee Benefits & Wellness Magazine](https://aimedalliance.org/aimed-alliance-op-ed-featured-in-hr-coms-employee-benefits-wellness-magazine/) - On January 22, 2021, HR.com featured an op-ed by Aimed Alliance’s counsel, Stacey Worthy, titled “Survey Finds Some Employers Deficient in Handling of Migraine Disease” in its Employee Benefits & Wellness Magazine. The op-ed highlights on recent survey results from our report “State of Migraine Disease in the Workplace 2021” as well as best practices
- [New Aimed Alliance Infographic Identifies Best Practices for Migraine Management in the Workplace](https://aimedalliance.org/new-aimed-alliance-infographic-identifies-best-practices-for-migraine-management-in-the-workplace/) - A new Aimed Alliance infographic demonstrates ongoing challenges employees with migraine disease face in the workplace and best practices employers can take to improve chances of success. The survey summarizes the findings of our recent study, “Migraine Disease in the Workplace 2021.” For example, about 60% of HR professionals recognize that migraine disease can be
- [Aimed Alliance Survey: State of Migraine Disease in the Workplace 2021](https://aimedalliance.org/aimed-alliance-survey-state-of-migraine-disease-in-the-workplace-2021/) - According to a new survey from Aimed Alliance in partnership with the the HR Research Institute, there is significant confusion among employers about whether migraine disease is considered a disability and wide variety in the extent to which employers offer both accommodations and appropriate benefits for employees with migraine disease. The survey, “State of Migraine
- [Aimed Alliance Asks HHS and CMS to Freeze and Revoke Recent Changes to the Medicaid Best Price Rule](https://aimedalliance.org/aimed-alliance-asks-hhs-and-cms-to-freeze-and-revoke-recent-changes-to-the-medicaid-best-price-rule/) - On February 3, 2021, Aimed Alliance submitted a letter requesting CMS freeze and revise a recently passed rule on Medicaid Value-Based Purchasing. The rule, which is scheduled to go into effect on March 1, 2021, would require copay assistance to be counted toward the calculation of a prescription medication’s best price if a health plan
- [Aimed Alliance Asks CMS and HHS to Freeze the NBPP 2022 and Reinstate Limitations on Copay Accumulator Programs](https://aimedalliance.org/aimed-alliance-asks-cms-and-hhs-to-freeze-the-nbpp-2022-and-reinstate-limitations-on-copay-accumulator-programs/) - On February 2, 2021, Aimed Alliance sent a letter to the Department for Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) asking the agencies to take the following actions regarding the Notice of Benefit and Payment Parameter for 2022 (NBPP 2022): Freeze the NBPP 2022 for 60 days; Open a
- [Aimed Alliance Submits Letters in Support of Maryland Bills Banning the Use of Copay Accumulators](https://aimedalliance.org/aimed-alliance-submits-letters-in-support-of-maryland-bills-banning-the-use-of-copay-accumulators/) - On February 1, 2021, Aimed Alliance submitted letters to Maryland legislators in support of SB290 and HB167. These bills, currently before the Senate Finance Committee and the House of Delegates Health and Government Operations Committee, would prevent insurance companies from using copay accumulator programs. Currently, many drug manufacturers offer cost-sharing assistance to patients designed to
- [Aimed Alliance Asks CMS to Reinstate Six Protected Classes Requirements](https://aimedalliance.org/aimed-alliance-asks-cms-to-reinstate-six-protected-classes-requirements/) - On January 28, 2021, Aimed Alliance submitted a letter requesting that the Centers for Medicare & Medicaid Services (CMS) reverse recent changes to the Part D Modernization Model for Calendar Year 2022 (PDM Model). Currently, Part D sponsors are required to include on their formularies “all or substantially all drugs” within six categories or classes
- [Aimed Alliance Submits Comment to CMS on Most Favored Nation Model](https://aimedalliance.org/aimed-alliance-submits-comment-to-cms-on-most-favored-nation-model/) - On January 26, 2021, Aimed Alliance submitted a comment to the Centers for Medicare & Medicaid Services (CMS) in response to the Most Favored Nation Model (Model) interim final rule. The Model is intended to cap reimbursement for 50 Medicare Part B drugs at the lowest price that drug manufacturers receive in other countries similar
- [Employers Show Significant Confusion Regarding Migraine Disease in the Workplace - According to New Study by the HR Research Institute and Aimed Alliance](https://aimedalliance.org/employers-show-significant-confusion-regarding-migraine-disease-in-the-workplace-according-to-new-study-by-the-hr-research-institute-and-aimed-alliance/) - Exclusive HR research from HR.com's Research Institute and Aimed Alliance. HR.com's Research Institute partnered with Aimed Alliance to investigate how employers perceive migraine disease, provide accommodations, and incorporate practices to help improve well-being and productivity. JACKSON'S POINT, ONTARIO (PRWEB) JANUARY 26, 2021 Migraine disease takes a heavy toll on employee well-being and productivity, but many organizations
- [CMS Finalizes Prior Authorization Rule, Limiting the Amount of Time Payers Can Take to Issue Decisions](https://aimedalliance.org/cms-finalizes-prior-authorization-rule-limiting-the-amount-of-time-payers-can-take-to-issue-decisions/) - On January 15, CMS finalized its rule altering requirements for Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and marketplace exchange plans to streamline the prior authorization process. This rule, first proposed on December 10, 2020, was finalized nine business days after the end of its comment period. Although Medicare
- [Aimed Alliance Asks UnitedHealthcare Not To Engage in Nonmedical Switching of Stable Patients](https://aimedalliance.org/aimed-alliance-asks-unitedhealthcare-not-to-engage-in-nonmedical-switching-of-stable-patients/) - On January 13, Aimed Alliance asked UnitedHealthcare to reconsider removing two medications that treat inflammatory bowel disease (IBD), rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis from its preferred products list. Under UnitedHealthcare’s current plan, two infliximab products would be excluded from its preferred products list, requiring current patients to meet new step therapy and
- [Aimed Alliance Hosts Webinar on Migraine in the Workplace for Employers](https://aimedalliance.org/aimed-alliance-hosts-webinar-on-migraine-in-the-workplace-for-employers/) - On January 14, 2021, Aimed Alliance hosted a webinar through HR.com titled “The State of Migraine Disease in the Workplace.” View the webinar below.
- [CMS Allows Tennessee to Adopt a Medicaid Closed Formulary Without Giving Up Rebates](https://aimedalliance.org/cms-allows-tennessee-to-adopt-a-medicaid-closed-formulary-without-giving-up-rebates/) - On January 8, 2021, the Centers for Medicare and Medicaid Services (CMS) approved a Tennessee waiver proposal for a demonstration project under § 1115 of the Social Security Act. The project provides a series of flexibilities, including giving the state authority to implement a “commercial-style” closed drug formulary without losing statutory Medicaid drug rebates. Namely,
- [Join Aimed Alliance and HR.com on January 14 on the State of Migraine Disease in the Workplace](https://aimedalliance.org/join-aimed-alliance-and-hr-com-on-january-14-on-the-state-of-migraine-disease-in-the-workplace/) - Join Aimed Alliance for a FREE webinar on January 14, 2021 at 3:00pm ET. Join Aimed Alliance and HR.com for a webinar on January 14, 2021 from 3:00 pm to 4:00 pm ET. This webinar will feature the findings of our new survey report, “The State of Migraine Disease in the Workplace 2020.” Despite common
- [New Article Argues for an Expansion of Diversity, Equity, and Inclusion Efforts Within Workforce Health Programs](https://aimedalliance.org/new-article-argues-for-an-expansion-of-diversity-equity-and-inclusion-efforts-within-workforce-health-programs/) - A new article from Bruce Sherman, MD, FCCP, FACOEM argues that employers should expand their diversity, equity and inclusion efforts to include workforce health. Namely, the authors emphasize the importance of considering the impact of socioeconomic, racial, and ethnic differences in determining equitable organizational structure, goals, and systems. The authors argue for three generalizable business
- [Aimed Alliance Submits Comment to NY Department of Health Regarding Safe CBD Consumption](https://aimedalliance.org/aimed-alliance-submits-comment-to-ny-department-of-health-regarding-safe-cbd-consumption/) - On December 23, 2020, Aimed Alliance submitted a comment to the New York Department of Health on a proposed rule to regulate cannabidiol (CBD) products sold in the state. Aimed Alliance expressed concern that the proposed rule allows high concentrations of CBD in food and dietary supplement products (up to 25mg per food product and
- [Aimed Alliance Submits a comment on the NBPP 2022](https://aimedalliance.org/aimed-alliance-submits-a-comment-on-the-nbpp-2022/) - On December 30, 2020, Aimed Alliance submitted a comment to the Centers for Medicare and Medicaid Serviced (CMS) on its “HHS Notice of Benefit and Payment Parameters for 2022” (NBPP 2022). The comment urged CMS to reinstate limitations on the use of copay accumulator programs as set forth in the NBPP 2020. The NBPP 2020
- [CMS Delays Two Years Policy Drug Makers Say Undermines Copay Coupons](https://aimedalliance.org/cms-delays-two-years-policy-drug-makers-say-undermines-copay-coupons/) - On December 21, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized a rule to alter the method by which “Medicaid best price” is calculated. In particular, the rule finalizes a controversial change requiring the value of copay assistance that drug makers provide to patients to be subtracted from best price calculations if a
- [Supreme Court Ruling Opens Door to State Regulations of PBMs](https://aimedalliance.org/supreme-court-ruling-opens-door-to-state-regulations-of-pbms/) - On December 10, 2020, the Supreme Court of the United States held that Arkansas Act 900 is not pre-empted by ERISA, opening the door to state regulations of pharmacy benefit managers (PBMs). The Arkansas law requires PBMs to reimburse pharmacies no less than what pharmacies pay for generic drugs, and was adopted due to concerns
- [CMS Unveils Rule to Streamline, Quicken Prior Authorization Decisions](https://aimedalliance.org/cms-unveils-rule-to-streamline-quicken-prior-authorization-decisions/) - On December 10, 2020, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule aimed at reducing the time payers take to issue a prior authorization decision and increasing payer data sharing to ease patient transfer between payers. Among other things, it requires Medicaid, CHIP, and Qualified Health Plan payers to issue decisions
- [Mandated Coverage of Marijuana as a Health Benefit? What Employers Need to Know](https://aimedalliance.org/mandated-coverage-of-marijuana-as-a-health-benefit-what-employers-need-to-know/) - Join Aimed Alliance for a FREE webinar on December 2, 2020 at 12:00pm ET. Join Aimed Alliance and the Society for Human Resource Management (SHRM) for a FREE webinar titled “Mandated Coverage of Marijuana as a Health Benefit? What Employers Need to Know” on December 2, 2020 from 12:00 pm ET to 1:00 pm ET.
- [UHC Delays Its Copay Accumulator Policy Days After Receiving Sign-on Letter](https://aimedalliance.org/uhc-delays-its-copay-accumulator-policy-days-after-receiving-sign-on-letter/) - Just days after Aimed Alliance sent UnitedHealthcare (UHC) a letter signed by 62 patient advocacy groups and professional associations, the insurer announced that it would delay the implementation of its copay accumulator policy. Read our letter here and UHC’s statement here.
- [Aimed Alliance Leads Effort to Tell UHC and WEA Trust Not To Implement Copay Accumulator Programs](https://aimedalliance.org/aimed-alliance-leads-effort-to-tell-uhc-and-wea-trust-not-to-implement-copay-accumulator-programs/) - Today, Aimed Alliance sent letters on behalf of several patient advocacy groups and professional associations to UnitedHealthcare (UHC) and WEA Trust, asking the health plans not to implement copay accumulator programs. Copay accumulator programs are health insurance policies that prohibit copay assistance from counting toward the plan enrollees’ deductibles or out-of-pocket maximums. Both UHC and
- [CMS’s New Transparency Rule Requires Plans to Disclose Copay Accumulator Programs and Other Details](https://aimedalliance.org/cmss-new-transparency-rule-requires-plans-to-disclose-copay-accumulator-programs-and-other-details/) - On October 29, 2020, the Centers for Medicare and Medicaid Services (CMS) released a new rule aimed at improving transparency in health plans. Among other things, it requires individual and group health plans to release a statement to consumers disclosing their cost-sharing requirements with respect to a certain treatment or service. The same statement must
- [Honolulu Civil Beat Covers Aimed Alliance Report on the Hawai’i Health Care System](https://aimedalliance.org/honolulu-civil-beat-covers-aimed-alliance-report-on-the-hawaii-health-care-system/) - On October 4, 2020, the Honolulu Civil Beat published an article written by Dr. Stephen B. Kemble titled “Hawaii Was Creating a Plan for Universal Health Care. It’s Time to Return to It.” The article highlights findings from Aimed Alliance’s recent report “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i” to support
- [Aimed Alliance and NORM Release Updated Medicare Open Enrollment Brochure](https://aimedalliance.org/aimed-alliance-and-norm-release-updated-medicare-open-enrollment-brochure/) - Medicare open enrollment runs from October 15, 2020 to December 7, 2020. Aimed Alliance and the National Organization of Rheumatology Management (NORM) have released their “2021 Medicare Open Enrollment” brochure with information updated for the 2021 plan year. This brochure serves as a value resource for individuals determining which Medicare plan is best for their
- [Aimed Alliance Asks NY Assembly Members to Support A8246](https://aimedalliance.org/aimed-alliance-asks-ny-assembly-members-to-support-a8246/) - On September 25, 2020, Aimed Alliance asked New York assembly members to support the passage of A8246, a bill that would limit health insurers’ use of copay accumulator programs. In particular, A8246 prohibits health insurers from adopting copay accumulator programs for a branded drug unless a medically appropriate generic medication is available. The bill is
- [GAO Report Reveals Insurance Reps’ Deceptive Practices When Selling Junk Plans](https://aimedalliance.org/gao-report-reveals-insurance-reps-deceptive-practices-when-selling-junk-plans/) - According to a new report released by the U.S. Government Accountability Office (GAO), some health insurance sales representatives are engaging in deceptive practices when selling short-term limited duration health insurance plans. Such plans do not need to comply with the Patient Protection and Affordable Care Act (ACA) and are permitted to discriminate on the basis
- [Aimed Alliance Letter to HealthPartners on Nonmedical Switching Highlighted in Pioneer Press](https://aimedalliance.org/aimed-alliance-letter-to-healthpartners-on-nonmedical-switching-highlighted-in-pioneer-press/) - On August 24, 2020, Iowa’s Pioneer Press covered a story about how health insurer, HealthPartners, implemented a nonmedical switching policy after the plan year had begun. The article highlights the letter that Aimed Alliance sent to the insurer on behalf of several health care practitioners and patients. You can read the article here and the
- [New Study Shows Out-of-Pocket Spending Decreased Significantly After States Cap the Copay](https://aimedalliance.org/new-study-shows-out-of-pocket-spending-decreased-significantly-after-states-cap-the-copay/) - According to a new study in the New England Journal of Medicine (NEJM), three states have helped their residents save money by capping out-of-pocket costs on specialty medications without increasing health plans' spending. Delaware, Maryland, and Louisiana all passed laws that capped drug copays at $150 for specialty medications. As a result, patients’ out-of-pocket spending
- [Aimed Alliance Hosts Webinar on Copay Accumulator Program for Employers](https://aimedalliance.org/aimed-alliance-hosts-webinar-on-copay-accumulator-program-for-employers/) - On July 29, 2020, Aimed Alliance hosted a webinar through HR.com titled “Copay Accumulators Part 2: A Legal and Regulatory Update, Data Trends, and Patient Spotlight.” View the webinar below.
- [Fact Sheet on Copay Accumulator Programs for Employers](https://aimedalliance.org/fact-sheet-on-copay-accumulator-programs-for-employers/) - Aimed Alliance released a new fact sheet titled “Copay Accumulator Programs: What Employers Need to Know.” The fact sheet explains what copay accumulator programs are, how they impact employees, and why they are used. It also provides an update on recent regulatory activity, including on the Notice of Benefit and Payment Parameters for 2021 and
- [#MeToo Meets the Emergency Room](https://aimedalliance.org/metoo-meets-the-emergency-room/) - Last month, the Saint Louis University Journal of Health Law & Policy published an article written by Aimed Alliance counsel, Stacey Worthy and Shruti Kulkarni, titled “#MeToo Meets the Emergency Room: Providing and Paying for Care After a Sexual Assault.” In the article, the authors identify several barriers to accessing and affording health care services
- [Fortune Publishes Aimed Alliance & Patients Rising Now Op-Ed on Regulation Impacting Copay Accumulator Programs](https://aimedalliance.org/fortune-publishes-aimed-alliance-patients-rising-now-op-ed-on-regulation-impacting-copay-accumulator-programs/) - On July 22, 2020, Fortune published an op-ed co-authored by Aimed Alliance counsel, Stacey Worthy, and Patients Rising Now executive director, Terry Wilcox. The op-ed discusses the Notice of Benefit and Payment Parameters for 2021, a new rule recently finalized by the Centers for Medicare and Medicaid Services. In particular, the authors highlight problems with
- [Aimed Alliance Asks HHS and CMS To Protect Patient Access By Scrapping Proposed Medicaid Rule](https://aimedalliance.org/aimed-alliance-asks-hhs-and-cms-to-protect-patient-access-by-scrapping-proposed-medicaid-rule/) - On July 16, 2020, Aimed Alliance submitted a comment to the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) to ask that the agencies abandon a proposed rule on Medicaid or limit the use of copay accumulators. If finalized, the rule would require that copay assistance
- [New Column Highlights Findings of Aimed Alliance Report on Hawaii Health Insurance Program](https://aimedalliance.org/new-column-highlights-findings-of-aimed-alliance-report-on-hawaii-health-insurance-program/) - On July 9, 2020, the Honolulu Star-Advertiser published a column by Dr. Tad Iwanuma that highlights the findings of Aimed Alliance’s report, “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i.” The column notes that health plans have responded to the COVID-19 public health crisis by loosening regulations, withdrawing monetary penalties, and developing
- [FDA Tests CBD Products to Determine If They Are Mislabeled and Adulterated](https://aimedalliance.org/fda-tests-cbd-products-to-determine-if-they-are-mislabeled-and-adulterated/) - On July 8, the U.S. Food and Drug Administration (FDA) sent a report titled “Sampling Study of the Current Cannabidiol Marketplace to Determine the Extent that Products Are Mislabeled or Adulterated” to the U.S. House and Senate Appropriations Committees. The report noted that in 2019, the FDA tested several CBD products to determine whether they
- [Copay Accumulators Part 2: A Legal and Regulatory Update, Data Trends, and Patient Spotlight](https://aimedalliance.org/copay-accumulators-part-2-a-legal-and-regulatory-update-data-trends-and-patient-spotlight/) - Join Aimed Alliance for a FREE webinar on July 29, 2020 at 3:00pm ET. When employees cannot afford their medications, they may rely on copay assistance (i.e., coupon cards from drug manufacturers). Copay assistance not only contributes toward the employees’ copayments or coinsurance but also count toward their annual deductibles and maximum out-of-pocket limits. However,
- [New CMS Rule Creates Disincentive for Drug Makers To Offer Copay Assistance](https://aimedalliance.org/new-cms-rule-creates-disincentive-for-drug-makers-to-offer-copay-assistance/) - The Centers for Medicare and Medicaid Services (CMS) proposed a new rule that could prevent drug makers from offering copay assistances to patients in need. The new rule acknowledges that health insurers, rather than patients, benefit from copay accumulator programs. However, CMS’s new proposed rule states that if a health plan implements a copay accumulator
- [Aimed Alliance Encourages Congress To Aid in Implementing Copay Accumulator Protections](https://aimedalliance.org/aimed-alliance-encourages-congress-to-aid-in-implementing-copay-accumulator-protections/) - Today, Aimed Alliance sent thank you letters to 74 members of the U.S. House of Representatives. At Aimed Alliance’s and Patients Rising Now’s urging, the members had written a letter calling on the Department of Health and Human Services (HHS) to implement certain patient protections into its Notice of Benefit and Payment Parameters for 2021
- [Aimed Alliance’s Updated Glossary of Health Insurance Terms Now Available](https://aimedalliance.org/aimed-alliances-updated-glossary-of-health-insurance-terms-now-available/) - Aimed Alliance recently updated its glossary of common health terms. Much of the jargon used by the health care industry is complex and confusing. This resource serves to explain many of those terms (e.g., copay accumulator program, nonmedical switching, coinsurance, deductible, or balance billing) in simple language. Check it out here.
- [Louisiana Enacts Stronger Step Therapy Legislation](https://aimedalliance.org/louisiana-enacts-stronger-step-therapy-legislation/) - On June 11, 2020, Louisiana Governor John Bel Edwards signed HB 263 into law. The new law includes stronger step therapy protections. Step therapy is a health insurance protocol in which a health plan requires a patient to try and fail on a certain medication before the patient can access the medication prescribed to him
- [The Maui News Publishes Our Op-ed on Hawaii Report](https://aimedalliance.org/the-maui-news-publishes-our-op-ed-on-hawaii-report/) - On June 13, 2020, The Maui News published “COVID-19 Shows that We Need To Rethink Hawaii’s Health Care System,” an op-ed written by Aimed Alliance counsel, Stacey Worthy. The op-ed highlights findings from our report “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i.” You can read the op-ed here and our report
- [Aimed Alliance Calls on Ohio House Health Committee to Consider Nonmedical Switching Bill](https://aimedalliance.org/aimed-alliance-calls-on-ohio-house-health-committee-to-consider-nonmedical-switching-bill/) - On June 1, 2020, Aimed Alliance sent a letter to the Ohio House Health Committee members, asking them to bring H.B. 418 to the floor for discussion and pass the bill. The bill would prohibit health insurers from making negative changes to their formularies, including by dropping a medication from coverage or increasing out-of-pocket costs—activities
- [Hawai’i Public Radio and Others Cover Our Study Showing Providers Struggle under Payment System](https://aimedalliance.org/hawaii-public-radio-reports-on-aimed-alliances-new-study-showing-providers-are-struggling-under-hmsas-payment-system/) - On May 28, 2020, Hawai’i Public Radio published an exclusive story covering Aimed Alliance’s new report “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i." The report reveals that many primary care providers are struggling to stay in business because of changes made to the way they are compensated by the state’s largest insurer,
- [Hawaii Health Care Professional Pens Op-Ed Highlighting the Findings of Aimed Alliance Report](https://aimedalliance.org/hawaii-health-care-professional-pens-op-ed-highlighting-the-findings-of-aimed-alliance-report/) - On June 3, 2020, Dr. Stephen B. Kemble, a psychiatrist and former Hawaii Health Authority member, drafted an op-ed covering our report “Trouble in Paradise: Assessing the Outcomes of Payment Transformation in Hawai’i.” In his op-ed, Dr. Kemble notes that HMSA’s Payment Transformation has some positive attributes, such as paying practitioners regardless of whether a
- [New Fact Sheet Explains Why States Should Pass Laws to Limit Copay Accumulators](https://aimedalliance.org/new-fact-sheet-explains-why-states-should-pass-laws-to-limit-copay-accumulators/) - Today, Aimed Alliance released a fact sheet that explains why states can and should pass laws that limit health insurers’ use of copay accumulator programs. Copay accumulator programs are health insurance policies that prevent copay assistance from counting toward a patient’s annual deductible or maximum out-of-pocket limit. As health care costs in the U.S. continue
- [Hawai’i Primary Care Providers Say Payment Plan Burdens Providers, Hurts Patient: New Report](https://aimedalliance.org/hawaii-primary-care-providers-say-hmsa-payment-plan-imposing-burdens-on-providers-hurting-patient-new-report/) - Survey Finds More Than Eight In Ten Primary Care Providers Would Not Recommend New Practitioner Come To Hawai’i As State Battles Physician Shortage Amid COVID-19 Crisis WASHINGTON, DC. — A new report released today found that changes to primary care provider (PCP) payment model by the Hawaii Medical Service Association (HMSA) has restricted practitioners’ ability to
- [Aimed Alliance and Others Ask Congress To Improve Access To Care During Public Health Emergency](https://aimedalliance.org/aimed-alliance-and-others-ask-congress-to-improve-access-to-care-during-public-health-emergency/) - On June 3, 2020, Aimed Alliance and 18 other patient advocacy groups sent a letter to Congress, asking it to temporarily prohibit prior authorization and step therapy requirements during the COVID-19 pandemic. Prior authorization is a health insurance policy in which health care practitioners must obtain permission from the health plan before prescribing or administering treatments
- [Aimed Alliance Offers Support for Ohio Bill that Would Limit Copay Accumulators](https://aimedalliance.org/aimed-alliance-offers-support-for-ohio-bill-that-would-limit-copay-accumulators/) - On June 1, 2020, Aimed Alliance sent a letter to the Ohio House Health Committee, urging its members to pass H.B. 469. If signed into law, the bill would limit the use of copay accumulator programs. Many patients who cannot afford their medications have obtained aid from copayment assistance programs, often in the form of
- [CMS Issues New Rule and Guidance Improving Access to Telehealth and Testing for Medicare Beneficiaries](https://aimedalliance.org/cms-issues-new-rule-and-guidance-improving-access-to-telehealth-and-testing-for-medicare-beneficiaries/) - On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule and a guidance document that provide hospitals with new flexibilities to help them respond to COVID-19. The interim final rule, titled “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency,” makes
- [FCC Announces Telehealth Grant Program for COVID-19](https://aimedalliance.org/fcc-announces-telehealth-grant-program-for-covid-19/) - On March 30, 2020, Ajit Pai, the Chairman of the Federal Communications Commission (FCC), announced plans to implement a $200 million grant program that would support health care providers’ use of telehealth in their response to Coronavirus Disease 2019 (COVID-19). If implemented, this program would leverage $200 million provided to the agency by the Coronavirus
- [CMS Grants Flexibilities to Home Health Agencies](https://aimedalliance.org/cms-grants-flexibilities-to-home-health-agencies/) - On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a guidance document that outlines new flexibilities that are being provided to home health agencies during the coronavirus public health emergency. During the public health emergency, Home Health Agencies (HHAs) will be allowed to deliver more services via telehealth during beneficiaries’ 30
- [Sec. Azar Requests Increased Scope of Licensure for Providers Amid Public Health Emergency](https://aimedalliance.org/sec-azar-requests-increased-scope-of-licensure-for-providers-amid-public-health-emergency/) - On March 24, 2020, U.S. Department of Health and Human Services (HHS) Sec. Azar sent a letter to governors across the U.S., requesting that they ease provider licensure and supervision requirements and increase liability protections for providers. Reducing provider licensure requirements would allow providers licensed in one state to deliver care to patients in another
- [HHS-OIG Issues Statement Balancing Need for Enforcement with Public Health Emergency](https://aimedalliance.org/hhs-oig-issues-statement-balancing-need-for-enforcement-with-public-health-emergency/) - On March 30, 2020, the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) issued a statement that outlined the agency’s approach to its oversight and enforcement responsibilities during the coronavirus public health emergency. The agency will offer the health care community flexibility to provide needed care during the emergency, including
- [The White House and CDC Recommend Homemade Cloth Facemasks for the General Public](https://aimedalliance.org/the-white-house-and-cdc-recommend-homemade-cloth-facemasks-for-the-general-public/) - On Friday, April 3, 2020, the White House urged Americans to wear homemade facemasks when they leave the house in efforts to prevent the spread of COVID-19. The guidance is in response to a growing concern that asymptomatic individuals could unwittingly transmit the disease while in public. Facemasks could slow that transmission. The guidance mirrors
- [Supreme Court Extends Briefing Schedule in ACA Case](https://aimedalliance.org/supreme-court-extends-briefing-schedule-in-aca-case/) - On April 3, 2020, the Supreme Court of the United States agreed to extend the briefing schedule in California v. Texas, the case challenging the constitutionality of the Patient Protection and Affordable Care Act. Initial briefs are now due in May, and oral arguments are expected in October. Continue reading.
- [Connecticut Issues Executive Order To Prevent Surprise Billing During COVID-19 Public Health Emergency](https://aimedalliance.org/connecticut-issues-executive-order-to-prevent-surprise-billing-during-covid-19-public-health-emergency/) - On April 5, 2020, Connecticut Governor issued an executive order to ban surprise out-of-network medical bills, effective immediately and for the duration of the COVID-19 public health emergency. The order also states that if a patient receives emergency services from an out-of-network provider, that provider will be paid the in-network rate for that service. Finally,
- [Insurers Offer Health Care Providers Advance Payment To Ease COVID-19 Financial Strain](https://aimedalliance.org/insurers-offer-health-care-providers-advance-payment-to-ease-covid-19-financial-strain/) - UnitedHealth Group and Blue Shield of California recently announced that they will provide health care practitioners with accelerated payments and other financial support to alleviate some of pressure from the COVID-19 public health emergency. UnitedHealth Group will be providing $2 billion and Blue Shield of California will be providing $200 million to practitioners and hospitals.
- [Aimed Alliance Submits Comments to FDA / FTC on Competitive Marketplace for Biosimilars](https://aimedalliance.org/aimed-alliance-submits-comments-to-fda-ftc-on-competitive-marketplace-for-biosimilars/) - On March 9, 2020, the U.S. Food and Drug Administration (FDA) and the Federal Trade Commission (FTC) held a workshop entitled “FDA/FTC Workshop on Competitive Marketplace for Biosimilars.” The agencies announced that the purpose of the workshop was to “discuss FDA and FTC’s collaborative efforts to support appropriate adoption of biosimilars, discourage false or misleading
- [Aimed Alliance Releases Fact Sheet on Expanded Home Health Services for Medicare Beneficiaries](https://aimedalliance.org/aimed-alliance-releases-fact-sheet-on-expanded-home-health-services-for-medicare-beneficiaries/) - Today, Aimed Alliance released a fact sheet entitled “Expansion of Home Health Services for Medicare Beneficiaries.” The fact sheet summarizes an interim final rule from the Centers for Medicare and Medicaid Services (CMS) that provides certain flexibilities to treat Medicare beneficiaries in their homes. For example, it allows a health care practitioner or home health
- [Aimed Alliance Sends Letter in Support of Tennessee Bill to Limit White Bagging and Brown Bagging](https://aimedalliance.org/aimed-alliance-sends-letter-in-support-of-tennessee-bill-to-limit-white-bagging-and-brown-bagging/) - On April 14, 2020, Aimed Alliance sent a letter to members of Tennessee’s Senate Committee on Commerce and Labor in support of Amendment 1 to Senate Bill No. 2847. If passed, the bill would allow individuals covered under a medical or pharmacy benefit contract to obtain specialty medications from their health care provider’s office without
- [Some Regulatory Relief Adopted During the COVID-19 Pandemic May Remain in Place After Pandemic Ends](https://aimedalliance.org/some-regulatory-relief-adopted-during-the-covid19-pandemic-may-remain-in-place-after-pandemic-ends/) - On April 15, 2020, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma noted that some of the regulations that CMS waived to address the COVID-19 public health emergency may remain in place even after the emergency ends. In particular, she voiced support for the regulatory changes that eased telehealth restrictions in Medicare, expanded
- [Aimed Alliance and the Alliance for Balanced Pain Management Release Know Your Rights Brochure for Patients with Arthritis](https://aimedalliance.org/aimed-alliance-and-afbpm-release-kyr-brochure-for-patients-with-arthritis/) - On March 25, 2020, Aimed Alliance and the Alliance for Balanced Pain Management (AfBPM) jointly released a new Know Your Rights brochure for patients with osteoarthritis and rheumatoid arthritis and their caregivers. This document provides an overview of osteoarthritis and rheumatoid arthritis diagnoses and treatment, common insurance barriers, and general legal rights that may be
- [Free Webinar: CBD in the Workplace: What Employers Need to Know](https://aimedalliance.org/free-webinar-cbd-in-the-workplace-what-employers-need-to-know/) - Join Aimed Alliance for a FREE webinar on May 28, 2020 from 3:00pm to 4:00 pm ET. This webinar will include: An overview of CBD products; Federal and state laws governing CBD products in the U.S.; Challenges associated with employees using CBD in the workplace; Employer considerations An overview of and takeaways from employment-related lawsuits
- [Aimed Alliance Leads Efforts to Ask CMS to Improve Access to Treatment for High Risk Medicare Beneficiaries](https://aimedalliance.org/aimed-alliance-leads-efforts-to-ask-cms-to-improve-access-to-treatment-for-high-risk-medicare-beneficiaries/) - On April 23, 2020, Aimed Alliance submitted sign-on letters to the Centers for Medicare and Medicaid Services (CMS) to request that the agency waive prior authorization and step therapy requirements for Medicare beneficiaries who are at high risk for severe illness due to COVID-19 during the public health emergency. Joined by 27 medical organizations and
- [Free Webinar: Dermatological Care in a time of COVID-19](https://aimedalliance.org/free-webinar-dermatological-care-in-a-time-of-covid19/) - Join Aimed Alliance for a FREE webinar on May 21, 2020 at 3:00pm ET. Are you interested in the implications that COVID-19 has on the dermatological care you and your family receive? Join Aimed Alliance and the Derma Care Access Network in a webinar conversation on the access, policy and legal implications that COVID-19 has
- [HHS Allows Plans to Implement Copay Accumulators Without Any Patient Protections](https://aimedalliance.org/hhs-allows-plans-to-implement-copay-accumulators-without-any-patient-protections/) - On May 7, 2020, the Departments of Health and Human Services (HHS) released its Notice of Benefit and Payment Parameters for 2021 final rule, which allows health plans to implement copay accumulator programs regardless of whether or not a generic alternative is available. When patients cannot afford their medications, they may rely on copay assistance
- [HHS OIG Warns of Scammers Offering Fake COVID-19 Testing To Steal Medicare Beneficiaries’ Info](https://aimedalliance.org/hhs-oig-warns-of-scammers-offering-fake-covid-19-testing-to-steal-medicare-beneficiaries-info/) - On March 23, 2020, the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) issued an alert that warns seniors of a new scam related to Coronavirus Disease 2019 (COVID-19) testing. Scammers are offering unapproved and illegitimate tests to Medicare beneficiaries in exchange for personal information, including Medicare information. The scammers are
- [DC Acting Insurance Commissioner Woods Issues New Coverage Requirements for COVID-19](https://aimedalliance.org/dc-acting-insurance-commissioner-woods-issues-new-coverage-requirements-for-covid-19/) - On March 20, 2020, Acting Commissioner Karima Woods of the District of Columbia Department of Insurance, Securities, and Banking issued an emergency order directing health insurance companies in the District of Columbia to (1) cover treatment for COVID-19 with no cost-sharing; and (2) waive cost-sharing for diagnosis, testing, and treatment for COVID-19 for out-of-network providers
- [Milken Institute Launches COVID-19 Treatment and Vaccine Tracker](https://aimedalliance.org/milken-institute-launches-covid-19-treatment-and-vaccine-tracker/) - The U.S. Food and Drug Administration (FDA) has not yet approved a vaccine or treatment for Coronavirus Disease 2019 (COVID-19). However, several companies around the world have begun developing vaccines and treatments in response to the global outbreak of the virus. As more companies engage in this effort, keeping track of the products that are
- [Surge in Unsubstantiated Claims that CBD May Prevent or Treat COVID-19](https://aimedalliance.org/surge-in-unsubstantiated-claims-that-cbd-may-prevent-or-treat-covid-19/) - As the coronavirus pandemic continues to evolve, a new surge of unsubstantiated claims that cannabidiol (CBD) may treat Coronavirus Disease 2019 (COVID-19) has emerged. For instance, spam text messages are being sent out to Americans that link to a fabricated Fox News article promoting CBD oil as a treatment for COVID-19. The fake site further
- [Covered California Report Projects Health Insurance Premiums Rising Up to 40% in 2021](https://aimedalliance.org/covered-california-report-projects-health-insurance-premiums-rising-up-to-40-in-2021/) - On March 23, 2020, Covered California, the state-based marketplace that connects California residents with health coverage options, released a policy brief in response to the growing spread of Coronavirus Disease 2019 (COVID-19). This report is titled “The Potential National Health Cost Impacts to Consumers, Employers and Insurers in the Commercial Market Due to COVID-19.” The
- [Aimed Alliance Again Asks Insurer to Amend Its Mandatory White-Bagging Policy](https://aimedalliance.org/aimed-alliance-again-asks-insurer-to-amend-its-mandatory-white-bagging-policy/) - On January 1, 2020, Blue Cross Blue Shield of Tennessee (BCBST) adopted a mandatory “white bagging” policy, in which health care providers are required to purchase practitioner-administered medications through a specialty pharmacy instead of through a specialty distributor. On February 5, 2020, Aimed Alliance sent a letter to BCBST to ask the insurer to amend
- [CMS Grants Program Flexibility to 11 More States for Medicaid and CHIP](https://aimedalliance.org/cms-grants-program-flexibility-to-11-more-states-for-medicaid-and-chip/) - On March 23, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that the agency has approved 11 additional waivers requested by states in response to the SARS-CoV-2 outbreak pursuant to Sec. 1135 of the Social Security Act. The authority to approve these requests is automatically granted to CMS whenever both the President of
- [CMS Issues Guidance on Extending Deadlines for Health Insurance Premiums Amid COVID-19 Outbreak](https://aimedalliance.org/cms-issues-guidance-on-extending-deadlines-for-health-insurance-premiums-amid-covid-19-outbreak/) - On March 24, 2020, the Center for Consumer Information & Insurance Oversight, an agency within the Centers for Medicare & Medicaid Services (CMS), released guidance titled “Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency.” This guidance applies to health insurance companies selling qualified health plans (QHPs) and stand-alone dental plans who may
- [CMS Issues Guidance on Telehealth Coverage and Use to Address COVID-19 Outbreak](https://aimedalliance.org/cms-issues-guidance-on-telehealth-coverage-and-use-to-address-covid-19-outbreak/) - On March 24, 2020, the Center for Consumer Information & Insurance Oversight, an agency within the Centers for Medicare & Medicaid Services (CMS), released a guidance document titled “FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19).” This FAQ contains information on how states
- [CMS Issues Guidance on Prescription Drug Refills During the COVID-19 Outbreak](https://aimedalliance.org/cms-issues-guidance-on-prescription-drug-refills-during-the-covid-19-outbreak/) - On March 24, 2020, the Center for Consumer Information & Insurance Oversight, an agency within the Centers for Medicare & Medicaid Services (CMS), released a guidance document titled “FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets.” This guidance document specifies
- [FDA Launches Program to Expedite Development of COVID-19 Treatments](https://aimedalliance.org/fda-launches-program-to-expedite-development-of-covid-19-treatments/) - On March 31, 2020, the U.S. Food and Drug Administration (FDA) announced the launch of the Coronavirus Treatment Acceleration Program (CTAP). The program was created to provide promising in-development Coronavirus Disease 2019 (COVID-19) treatments to patients while using preliminary data to evaluate whether the treatments are safe and effective. There are currently 10 COVID-19 therapeutic
- [Aimed Alliance Releases Position Statement on Cannabidiol (CBD)](https://aimedalliance.org/aimed-alliance-releases-position-statement-on-cannabidiol-cbd/) - On March 30, 2020, Aimed Alliance published a position statement on products containing cannabidiol (CBD). This policy document describes how recent changes in federal law have led to products containing CBD being broadly marketed and sold to consumers and explores product safety issues that have arisen since then. The statement also outlines Aimed Alliance’s policy
- [Aimed Alliance Celebrates National Triglycerides Day to Spread Awareness of Cardiovascular Disease](https://aimedalliance.org/aimed-alliance-celebrates-national-triglycerides-day-to-spread-awareness-of-cardiovascular-disease/) - March 28, 2020 is the third annual National Triglycerides Day, the first of which was commemorated on March 28, 2018. National Triglycerides Day is an awareness day that emphasizes to patients the value of knowing their triglyceride levels and the importance of diet and exercise for those wishing to live a healthier lifestyle. Many patients
- [CMS Clarifies Conditions of Enhanced Funding for State Medicaid Programs](https://aimedalliance.org/cms-clarifies-conditions-of-enhanced-funding-for-state-medicaid-programs/) - On March 18, 2020, federal lawmakers enacted the Families First Coronavirus Response Act, which contained a provision that provides enhanced federal funding for state Medicaid programs if they meet certain requirements. The new law provides a 6.2 percent increase in the Federal Medical Assistance Percentage (FMAP), which states receive from Congress for Medicaid program expenses,
- [Senate Passes Coronavirus Stimulus Package, House to Vote Today](https://aimedalliance.org/senate-passes-coronavirus-stimulus-package-house-to-vote-on-today/) - On March 25, 2020, the U.S. Senate unanimously passed S. 3548, titled the “Coronavirus Aid, Relief, and Economic Security (CARES) Act,” with a 96-0 vote. The legislation faced several days of bipartisan negotiation and last-minute opposition in the upper chamber, but compromises were reached between Democrat and Republican leadership by the end of the day,
- [Trump Administration “Considering Other Options” Instead of Coronavirus Special Enrollment Period](https://aimedalliance.org/trump-administration-considering-other-options-instead-of-coronavirus-special-enrollment-period/) - Consumers are generally able to enroll in a commercial health insurance plan through the healthcare.gov website during the open enrollment period between November and December each year unless they experience an event that qualifies them for a special enrollment period, such as losing a job or getting married. However, the state and federal governments also
- [Several Insurers Waive Cost-Sharing for COVID-19 Treatment](https://aimedalliance.org/several-insurers-waive-cost-sharing-for-covid-19-treatment/) - On March 30, 2020, Cigna and Humana announced that they will be waiving the costs associated with Coronavirus Disease 2019 (COVID-19) treatment. The week prior, CVS Health had announced that Aetna will be waiving cost-sharing associated with COVID-19 hospital admissions. With these changes in effect, enrollees of these health plans will not have to satisfy
- [Free Webinar: Providing Quality Benefits for Employees with Inflammatory Bowel Disease and Other Chronic Conditions](https://aimedalliance.org/free-webinar-providing-quality-benefits-for-employees-with-inflammatory-bowel-disease-and-other-chronic-conditions/) - Join Aimed Alliance for a FREE webinar on May 6, 2020 from 1:00pm to 2:00 pm ET. This webinar will include: The impact of inflammatory bowel disease (IBD) in the workplace and the negative consequences of receiving improper treatment; Workplace benefits that can assist employees with IBD; Options for workplace accommodations and wellness programs; and
- [CMS Provides Additional Flexibility for Ambulances and Dialysis Clinics in Response to Coronavirus Outbreak](https://aimedalliance.org/cms-provides-additional-flexibility-for-ambulances-and-dialysis-clinics-in-response-to-coronavirus-outbreak/) - The Centers for Medicare & Medicaid Services (CMS) has issued several waivers and guidance documents amid the coronavirus outbreak that are intended to improve the ability of the U.S. health care system to respond to the COVID-19 outbreak. Among these are additional flexibilities for End-Stage Renal Disease (ESRD) and dialysis providers, which allow dialysis facilities
- [CMS Announces Expanded Telehealth Coverage During Public Health Emergency](https://aimedalliance.org/cms-announces-expanded-telehealth-coverage-during-public-health-emergency/) - On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare will provide coverage for over 80 additional services when they are delivered via telehealth. These changes are intended to increase access to care for Medicare enrollees while allowing them to remain isolated to protect them from exposure to coronavirus. Examples
- [Supreme Court Grants Certiorari in Texas v. Azar](https://aimedalliance.org/supreme-court-grants-certiorari-in-texas-v-azar/) - On March 2, 2020, the Supreme Court of the United States granted certiorari in Texas v. Azar, agreeing to hear the case but declining to specify when the case will be heard. If the Court proceeds normally, the case will likely be heard in the Fall and a decision can be expected in mid-2021. The
- [Insurers Oppose Price Transparency Rule and Request an Implementation Delay](https://aimedalliance.org/insurers-oppose-price-transparency-rule-and-request-an-implementation-delay/) - On November 15, 2019, the Trump Administration released a proposed rule that would require health plans to disclose cost-sharing estimates to enrollees and to publicly release negotiated rates for in-network providers and historical allowed amounts for out-of-network providers. The proposed rule was designed to increase transparency among health plans and to equip consumers with more
- [Kentucky Banking and Insurance Committee Passes Copay Accumulator Bill](https://aimedalliance.org/kentucky-banking-and-insurance-committee-passes-copay-accumulator-bill/) - On March 4, 2020, Kentucky HB 72, a bill that would limit the use of copay accumulator programs by health plans, was discussed during a House Banking and Insurance Committee hearing. Copay accumulator programs are policies that health plans use to prevent cost-sharing amounts paid on behalf of plan enrollees from counting towards their maximum
- [New Report by Digital Citizens Alliance Analyzes the Growing CBD Industry and the Need for Regulation](https://aimedalliance.org/new-report-by-digital-citizens-alliance-analyzes-the-growing-cbd-industry-and-the-need-for-regulation/) - On March 5, 2020, Digital Citizens Alliance, a non-profit organization that is consumer-oriented and focused on educating the public and policymakers on the threats that consumers face on the internet, released a new report on cannabidiol (CBD) products. The report, titled “CBD Confusion: How Consumers Can Be Misled and Why the Market Needs Adult Supervision
- [FDA Issues Report to Congress on CBD Products](https://aimedalliance.org/fda-issues-report-to-congress-on-cbd-products/) - On March 5, 2020, the U.S. Food and Drug Administration (FDA) issued a report to Congress that discusses the agency’s progress toward obtaining and analyzing data to help determine a policy of enforcement discretion and how hemp-derived cannabidiol (CBD) can be used in FDA-regulated products. The FDA was charged with creating the report as a
- [Several Insurers Waive Cost-Sharing for Coronavirus Testing](https://aimedalliance.org/several-insurers-waive-cost-sharing-for-coronavirus-testing/) - As of March 10, 2020, over 100,000 people have been infected with and over 4,000 people have died from coronavirus around the world. In response to the viral outbreak, governments are pursuing strategies to slow the spread of the virus. For example, Italy has implemented a country-wide quarantine for its 60 million citizens after 168
- [FDA and FTC Warn 7 Companies Against Marketing Unapproved Coronavirus Therapies](https://aimedalliance.org/fda-and-ftc-warn-7-companies-against-marketing-unapproved-coronavirus-therapies/) - On March 6, 2020, the U.S. Food and Drug Administration (FDA) and the U.S. Federal Trade Commission (FTC) sent warning letters to seven companies that were marketing products that they falsely claimed would cure, treat, or prevent coronavirus. The agencies took this enforcement action because the advertised products “are unapproved drugs that pose significant risks
- [In Response to Coronavirus, Washington Opens a Special Enrollment Period for Health Insurance](https://aimedalliance.org/in-response-to-coronavirus-washington-opens-a-special-enrollment-period-for-health-insurance/) - On March 10, 2020, the Washington Health Benefit Exchange opened a special enrollment period that will allow uninsured consumers to enroll in a health insurance plan through the Washington Healthplanfinder. The special enrollment period will remain open through April 8, 2020. Washington is the first state to open a special enrollment period in response to
- [Aimed Alliance Leads Sign-on Letter to HealthPartners, Cautioning Against Nonmedical Switching Practices](https://aimedalliance.org/aimed-alliance-leads-sign-on-letter-to-healthpartners-cautioning-against-nonmedical-switching-practices/) - On March 9, 2020, Aimed Alliance sent a sign-on letter to HealthPartners, which is a nonprofit health care provider and health insurance company located in Minnesota and operating nationwide. The letter, joined by 25 health care providers and patient advocates, was sent in response to the health insurer’s decision to end coverage for a medication
- [Aimed Alliance Joins Sign-on Letter Supporting Passage of Kentucky Copay Accumulator Legislation](https://aimedalliance.org/aimed-alliance-joins-sign-on-letter-supporting-passage-of-kentucky-copay-accumulator-legislation/) - On March 11, 2020, Aimed Alliance joined a coalition of patient advocacy groups and provider associations in a sign-on letter sent to Kentucky legislators in support of Kentucky HB 72. This legislation, passed by the Kentucky House Banking and Insurance Committee on March 4, 2020, would limit the use of copay accumulator programs by health
- [IRS Agrees to Allow Employer-Sponsored HDHPs to Waive Cost-Sharing for Coronavirus Testing and Treatment](https://aimedalliance.org/irs-agrees-to-allow-employer-sponsored-hdhps-to-waive-cost-sharing-for-coronavirus-testing-and-treatment/) - On March 10, 2020, the American Benefits Council (ABC) asked the Internal Revenue Service (IRS) to clarify whether waiving cost-sharing for coronavirus testing and treatment before an enrollee’s deductible is met would disqualify enrollees or their employers from contributing to Health Savings Accounts (HSAs). Employers requested this clarity from the IRS because they feared they
- [Trump Declares National Emergency, Announces Efforts to Increase Access to Care During Pandemic](https://aimedalliance.org/trump-declares-national-emergency-announces-efforts-to-increase-access-to-care-during-pandemic/) - On March 13, 2020, the White House issued a proclamation announcing a national emergency in response to coronavirus, which has now become a pandemic according to the World Health Organization (WHO). Separately, the Secretary of the Department of Health and Human Services declared a public health emergency in response to coronavirus on January 31, 2020.
- [Hospitals and Insurers Launch Efforts to Address Cost of Coronavirus Treatment](https://aimedalliance.org/hospitals-and-insurers-launch-efforts-to-address-cost-of-coronavirus-treatment/) - As coronavirus continues to rapidly spread across the country, the capacity and responsiveness of the United States health care system is being tested. Additionally, the high costs associated with treating Coronavirus Disease 2019 (COVID-19) threaten to strain Americans’ financial resources in an environment where extravagant medical costs cause over 60 percent of all bankruptcies. To
- [Citizenship and Immigration Services Announces Coronavirus Exception to Public Charge Rule](https://aimedalliance.org/citizenship-and-immigration-services-announces-coronavirus-exception-to-public-charge-rule/) - On February 24, 2020, U.S. Citizenship and Immigration Services (USCIS) implemented the Inadmissibility on Public Charge Grounds final rule, which amended the process that the Department of Homeland Security uses to determine if someone applying for citizenship or a change in their citizenship status is likely to become a public charge. The final rule specifies
- [Aimed Alliance Joins Sign-On Letter Supporting the Federal Safe Step Act](https://aimedalliance.org/aimed-alliance-joins-sign-on-letter-supporting-the-federal-safe-step-act/) - On March 6, 2020, the National Psoriasis Foundation delivered a sign-on letter to the House and Senate sponsors of the Safe Step Act. Aimed Alliance, along with 49 other patient advocacy organizations and provider associations, joined the letter to voice the community’s support for this important legislation. The Safe Step Act, H.R. 2279/S. 2546, would
- [Op-ed by Aimed Alliance Counsel Published in Washington Times-Reporter](https://aimedalliance.org/op-ed-by-aimed-alliance-counsel-published-in-washington-times-reporter/) - On March 16, 2020, the Washington Times-Reporter published an op-ed by Aimed Alliance Counsel Stacey L. Worthy. This opinion piece discusses how health care access barriers, such as prior authorization and step therapy, can harm patients. Additionally, Ms. Worthy analyzes the implementation of new patient protection laws in Illinois, the degree to which health plans
- [President Signs Second Coronavirus Relief Package into Law, Third Relief Package Forthcoming](https://aimedalliance.org/president-signs-second-coronavirus-relief-package-into-law-third-relief-package-forthcoming/) - On March 14, 2020, the U.S. House of Representatives passed the second coronavirus relief package, titled the Families First Coronavirus Response Act, which provides additional resources for Americans during the coronavirus outbreak. The Families First Coronavirus Response Act follows the first relief package that was signed into law on March 6, 2020, which was titled
- [CMS Allows Catastrophic Plans To Offer Immediate Coverage for COVID-19 Diagnosis and Treatment](https://aimedalliance.org/cms-allows-catastrophic-plans-to-offer-immediate-coverage-for-covid-19-diagnosis-and-treatment/) - On March 18, 2020, the Centers for Medicare and Medicaid Services (CMS) issued an FAQ document announcing that catastrophic health plans can provide coverage for the diagnosis and treatment of Coronavirus Disease 2019 (COVID-19) even before enrollees meet their plan deductible requirements. Catastrophic health plans are a type of high-deductible health plan for individuals under
- [Third Coronavirus Relief Package Introduced in U.S. Senate](https://aimedalliance.org/third-coronavirus-relief-package-introduced-in-u-s-senate/) - On March 19, 2020, Sen. McConnell introduced the Coronavirus Aid, Relief, and Economic Security (CARES) Act in the U.S. Senate, which is the third relief package that will be considered by Congress in less than a month. While the first package focused on funding for federal health agencies and public health measures and the second
- [Kaiser Family Foundation Releases Research on State Efforts to Address Coronavirus Outbreak](https://aimedalliance.org/kaiser-family-foundation-releases-research-on-state-efforts-to-address-coronavirus-outbreak/) - In response to growing concerns about the rapid spread of coronavirus across the country, state governments have implemented a variety of policies designed to slow the spread of the virus and increase access to testing and treatment for those exposed to it. The Kaiser Family Foundation has compiled data about these policies and published it
- [Georgia’s Sec. 1332 Waiver Proposal Invites Legal Challenges](https://aimedalliance.org/georgias-sec-1332-waiver-proposal-invites-legal-challenges/) - On December 23, 2019, Georgia submitted a 1332 waiver application to the Centers for Medicare & Medicaid Services (CMS) to restructure the state’s insurance marketplace. Sec. 1332 of the Patient Protection and Affordable Care Act (ACA) allows states to make changes to their insurance marketplaces to provide their residents with high quality and affordable health
- [Supreme Court Rejects Motion to Delay Briefings in Texas v. Azar](https://aimedalliance.org/supreme-court-rejects-motion-to-delay-briefings-in-texas-v-azar/) - Earlier this month, a coalition of state attorneys general appealed the decision of the U.S. Court of Appeals for the Fifth Circuit and petitioned the Supreme Court of the United States to review Texas v. Azar, which challenges the constitutionality of the Patient Protection and Affordable Care Act (ACA). On January 24, 2020, the Supreme
- [Aimed Alliance Opposes Oregon Legislation that Could Restrict Access to Dialysis](https://aimedalliance.org/aimed-alliance-opposes-oregon-legislation-that-could-restrict-access-to-dialysis/) - On January 27, 2020, Oregon legislators introduced HB 4114, which would set physician payment rates for dialysis treatment at the Medicare payment rate. On February 3, 2020, Aimed Alliance submitted a letter of opposition to members of Oregon’s House Committee on Health Care. Aimed Alliance opposes this legislation because it may reduce the ability of
- [Department of Justice Asks Supreme Court Not to Review Texas v. Azar](https://aimedalliance.org/department-of-justice-asks-supreme-court-not-to-review-texas-v-azar/) - On February 3, 2020, the U.S. Department of Justice (DOJ) filed a brief with the Supreme Court of the United States, arguing that the Court’s immediate review of Texas v. Azar is not necessary. In this brief, the DOJ requests that the court not review Texas v. Azar until the U.S. District Court for the
- [“Healthy Adult Opportunity” Program Targets State Medicaid Spending at the Expense of Enrollees](https://aimedalliance.org/healthy-adult-opportunity-program-targets-state-medicaid-spending-at-the-expense-of-enrollees/) - On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced the “Healthy Adult Opportunity” demonstration program, which will allow participating states to adopt a closed formulary. To participate in the program, states must accept a spending cap on the amount of money that the federal government will contribute towards expenses for the
- [Proposed CMS Policy Will Allow Insurers to Broadly Implement Copay Accumulators](https://aimedalliance.org/proposed-cms-policy-will-allow-insurers-to-broadly-implement-copay-accumulators/) - On January 31, 2020, the Centers for Medicare & Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters for 2021 (NBPP 2021). The Notice of Benefit and Payment Parameters is an annual rule that outlines the benefit and payment policies that will govern health plans in the coming year. For the 2021
- [Idaho Insurers File Amicus Brief in Short-Term Plan Lawsuit](https://aimedalliance.org/idaho-insurers-file-amicus-brief-in-short-term-plan-lawsuit/) - On January 28, 2020, Idaho, along with two insurers selling “Enhanced Short-Term Plans” in the state, Blue Cross Idaho and SelectHealth, filed an amicus brief with the U.S. Court of Appeals for the D.C. Circuit. This brief was filed in advance of oral arguments in Association for Community Affiliated Plans v. U.S. Department of Treasury,
- [Insurers Increasingly Issue Retrospective Denials, Leaving Patients Stranded](https://aimedalliance.org/insurers-increasingly-issue-retrospective-denials-leaving-patients-stranded/) - On February 7, 2020, Kaiser Health News reported on a health insurer tactic growing in popularity: retrospective denial. A retrospective denial occurs when a patient receives prior approval from their health insurer to receive a health care treatment or service and the health insurer afterward decides that the benefit will not be covered because it
- [CMS Seeks Additional Information on Georgia’s Sec. 1332 Waiver Application](https://aimedalliance.org/cms-seeks-additional-information-on-georgias-sec-1332-waiver-application/) - On February 6, 2020, the Centers for Medicare & Medicaid Services (CMS) sent a letter to Georgia Gov. Brian Kemp, announcing that the reinsurance portion of Georgia’s 1332 waiver application is complete. The announcement allows the agency to begin the 180-day notice-and-comment period on that section of Georgia’s waiver application. However, CMS paused its preliminary
- [Aimed Alliance Releases 2019 Annual Report](https://aimedalliance.org/aimed-alliance-releases-2019-annual-report/) - Aimed Alliance experienced significant growth in 2019, and we are excited to share our progress with you. In our 2019 Annual Report, you can review the projects we completed over the course of the year and gain insight into what we've done in 2020. In the 2019 Annual Report, you’ll find: Profiles of Aimed Alliance
- [Appeals Court Invalidates Medicaid Work Requirements in Arkansas](https://aimedalliance.org/appeals-court-invalidates-medicaid-work-requirements-in-arkansas/) - On February 14, 2020, the U.S. Court of Appeals for the D.C. Circuit issued its decision in Gresham v. Azar. This follows the decision issued by the U.S. District Court for the District of Columbia on March 27, 2019, which held that the Secretary of the U.S. Department of Health and Human Services acted arbitrarily
- [Number of Consumers Newly Enrolled Through Covered California Jumps 41 Percent](https://aimedalliance.org/number-of-consumers-newly-enrolled-through-covered-california-jumps-41-percent/) - On February 18, 2020, California officials reported that enrollment in Covered California increased by 1.6 percent during the recent open enrollment period. Much of this enrollment increase is attributed to a 41 percent increase in new enrollees over previous years. Overall enrollment in Covered California is likely caused by the state-level coverage mandate that California
- [Aimed Alliance Counsel Authors Op-ed Published by the Gotham Gazette](https://aimedalliance.org/aimed-alliance-counsel-authors-op-ed-published-by-the-gotham-gazette/) - On February 21, 2020, the Gotham Gazette published an op-ed authored by Aimed Alliance Counsel Stacey L. Worthy. This op-ed discusses the findings of a report recently published by Aimed Alliance, titled “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from New York,” which analyzes how well
- [Aimed Alliance Responds to the Administration’s Notice of Benefit and Payment Parameters for 2021](https://aimedalliance.org/aimed-alliance-responds-to-the-administrations-notice-of-benefit-and-payment-parameters-for-2021/) - On January 31, 2020, the Centers for Medicare & Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters for 2021 (NBPP 2021). The Notice of Benefit and Payment Parameters is an annual rule that outlines the benefit and payment policies that will govern health plans in the coming year. For the 2021
- [Pennsylvania Health Advocates Attest to the Harms Caused by Mid-Year Formulary Changes](https://aimedalliance.org/pennsylvania-health-advocates-attest-to-the-harms-caused-by-mid-year-formulary-changes/) - On February 18, 2020, the Pennsylvania House Consumer Affairs Committee held a hearing on HB 853, which would amend the state’s Unfair Insurance Practices Act to prohibit changes to health insurance policies in the middle of the plan year when an enrollee has already received treatment under that policy. During this hearing, health advocates testified
- [Aimed Alliance Op-ed Featured in POLITICO](https://aimedalliance.org/aimed-alliance-op-ed-featured-in-politico/) - On February 24, 2020, the New York Health Care section of POLITICO featured the op-ed authored by Aimed Alliance Counsel Stacey L. Worthy, which was originally published in the Gotham Gazette on February 21, 2020. This op-ed discussed the need for New York to take additional steps to enforce consumer protection laws related to health
- [New Report Identifies Hazards of Short-Term Health Plans](https://aimedalliance.org/new-report-identifies-hazards-of-short-term-health-plans/) - On February 25, 2020, the Leukemia & Lymphoma Society released a report that underscores how short-term health plans offer coverage that is inadequate for many consumers. The report, based on a study conducted by Milliman, Inc., analyzes the costs faced by patients who are enrolled in short-term plans and who need treatment for any of
- [Copay Coupon App Exposes Personal Medical Information to Advertisers](https://aimedalliance.org/copay-coupon-app-exposes-personal-medical-information-to-advertisers/) - A recent article by Consumer Reports explored a controversy involving the GoodRx application, which allegedly allows consumers to obtain coupons for prescription drugs. Following reports that the GoodRx application is sharing consumers’ personal details with other internet-based companies like Facebook and Google, Consumer Reports investigated how the application operated. Consumer Reports used the application to
- [Aimed Alliances Summits Comment to FDA in Support of Approval for Cardiovascular Treatment](https://aimedalliance.org/aimed-alliances-summits-comment-to-fda-in-support-of-approval-for-cardiovascular-treatment/) - On October 30, 2019, Aimed Alliance summitted a comment to the U.S. Food and Drug Administration (FDA) Endocrinologic and Metabolic Drugs Advisory Committee. In the comment, Aimed Alliance recommended that the Committee approve the pending supplemental new drug application for Vascepa to reduce the risk of cardiovascular events as an adjunct to statin therapy in
- [NY Gov. Cuomo Vetoes Two Consumer Protection Bills](https://aimedalliance.org/ny-gov-cuomo-vetoes-two-consumer-protection-bills/) - On Dec. 23, 2019, NY Governor Andrew Cuomo vetoed AB 2969-A, which would prohibit health plans from making changes to their formulary during the plan year. In vetoing this bill, Gov. Cuomo argued that health plans would have to anticipate future drug price increases, which would raise premiums for enrollees. To view the governor’s veto
- [New Website Feature Provides Information on Health Care Reform Lawsuits](https://aimedalliance.org/new-website-feature-provides-information-on-health-care-reform-lawsuits/) - On December 27, 2019, Aimed Alliance launched a new section on its website that features case summaries of lawsuits that pertain to the Patient Protection and Affordable Care Act (ACA) and related health care reform topics. These summaries include historical information about each lawsuit, descriptions of major court decisions, links to those decisions, and a
- [Aimed Alliance Publishes a Report Analyzing New York's Prior Authorization and Step Therapy Laws](https://aimedalliance.org/aimed-alliance-publishes-a-report-analyzing-new-york-prior-authorization-and-step-therapy-laws/) - On January 2, 2020, Aimed Alliance published a report titled “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from New York.” This report, the first installment of a three-part series, is based on a recent survey commissioned by Aimed Alliance. It gauges the degree to which health
- [Consumers File Two Class Action Lawsuits in California Against CBD Companies](https://aimedalliance.org/consumers-file-two-class-action-lawsuits-in-california-against-cbd-companies/) - On Nov. 27, 2019, a group of consumers in California filed a class action lawsuit against Infinite Product Company, LLC, which is a Colorado-based company that manufactures, markets, and sells cannabidiol (CBD) products throughout the United States. The suit, filed in the United States District Court for the Central District of California, alleges that the
- [U.S. Attorneys General Appeal 5th Circuit Decision in Texas v. Azar Finding Parts of ACA Unconstitutional to the Supreme Court of the United States](https://aimedalliance.org/u-s-attorneys-general-appeal-5th-circuit-decision-in-texas-v-azar-finding-parts-of-aca-unconstitutional-to-the-supreme-court-of-the-united-states/) - On January 3, 2020, a coalition of 20 U.S. Attorneys General filed an appeal of a recent decision by the U.S. Court of Appeals for the Fifth Circuit in Texas v. U.S. The decision affirmed the lower court’s holding that the individual mandate provision of the Patient Protection and Affordable Care Act (ACA) was no
- [Aimed Alliance Submits Comment to U.S. Agriculture in Response to Hemp Rule](https://aimedalliance.org/aimed-alliance-submits-comment-to-u-s-agriculture-in-response-to-hemp-rule/) - On Jan. 6, 2020, Aimed Alliance submitted a comment to the U.S. Department of Agriculture’s (USDA) interim final rule, which establishes a domestic hemp production program to be managed by the Agricultural Marketing Service (AMS). In this comment, Aimed Alliance voices support for the agency’s approach to limiting the amount of tetrahydrocannabinol (THC) that can
- [Aimed Alliance Publishes a Report Analyzing Illinois’s Prior Authorization and Step Therapy Laws](https://aimedalliance.org/aimed-alliance-publishes-a-report-analyzing-illinoiss-prior-authorization-and-step-therapy-laws/) - On January 9, 2020, Aimed Alliance published a report titled “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from Illinois.” This report, the second installment of a three-part series, is based on a recent survey commissioned by Aimed Alliance. It gauges the degree to which health plans
- [Aimed Alliance Publishes a Report Analyzing Texas’s Prior Authorization and Step Therapy Laws](https://aimedalliance.org/aimed-alliance-publishes-a-report-analyzing-texass-prior-authorization-and-step-therapy-laws/) - On January 9, 2020, Aimed Alliance published a report titled “Utilization Mismanagement: Assessing Compliance with Step Therapy and Prior Authorization Laws in Select States, Survey Findings from Texas.” This report, the final installment of a three-part series, is based on a recent survey commissioned by Aimed Alliance. It gauges the degree to which health plans are complying
- [Aimed Alliance Adds Rutledge v. PCMA to Lawsuit Tracker](https://aimedalliance.org/aimed-alliance-adds-rutledge-v-pcma-to-lawsuit-tracker/) - On January 10, 2019, Aimed Alliance added a new category to the health care reform lawsuit tracker, which will track cases that involve Pharmacy Benefit Managers (PBMs). The first case to be added is Rutledge v. Pharmaceutical Care Management Association (PCMA), which is a national trade association that represents the interests of PBMs. This case
- [U.S. Solicitor General Urges Supreme Court Not to Review Texas v. Azar](https://aimedalliance.org/u-s-solicitor-general-urges-supreme-court-not-to-review-texas-v-azar/) - In late 2019, the U.S. Court of Appeals for the Fifth Circuit upheld the lower court’s ruling in Texas v. Azar that the Patient Protection and Affordable Care Act (ACA) individual mandate is an unconstitutional exercise of Congress’s Tax Power. However, the Fifth Circuit disagreed with the lower court’s analysis that supported invalidating the entire
- [New Consumer Protection Laws Become Effective in Colorado, Texas, and Washington State](https://aimedalliance.org/new-consumer-protection-laws-become-effective-in-colorado-texas-and-washington-state/) - On Jan. 1, 2020, surprise medical bill laws became effective in Colorado, Texas, and Washington state. Colorado Governor Polis signed HB19-1174 into law on May 14, 2019. This law creates an arbitration process to settle billing disputes between health insurers and health care providers in emergency situations. This law also caps what out-of-network providers can
- [Aimed Alliance Publishes a Comparison of the U.S. and German Health Systems](https://aimedalliance.org/aimed-alliance-publishes-a-comparison-of-the-u-s-and-german-health-systems/) - Conversations around health care reform often include comparisons to other health care systems. While the U.S. health care system is highly complex, Germany uses a multi-payer system that possesses many similarities. Understanding the commonalities and differences between these health systems could be instructive as policymakers weigh possible health care reforms. On Jan. 13, 2020, Aimed
- [Supreme Court Declines to Expedite Review of Texas v. Azar](https://aimedalliance.org/supreme-court-declines-to-expedite-review-of-texas-v-azar/) - On January 21, 2020, the Supreme Court of the United States released an order, declining to expedite the review of Texas v. Azar. Expedited review was requested by a coalition of attorneys general on January 3, 2020 and opposed by the Solicitor General of the United States on January 10, 2020. If granted, the Court
- [House Democrats and Advocates File Amici Briefs in Short-Term Plan Lawsuit](https://aimedalliance.org/house-democrats-and-advocates-file-amici-briefs-in-short-term-plan-lawsuit/) - House Democrats, as well as AARP, a coalition of patient advocates, and a coalition of provider associations all recently filed amici briefs in support of the stakeholders who are challenging the administration’s short-term, limited-duration insurance plan rule. This rule expanded the limits on the duration of short-term, limited-duration health plans from 3 months to 364
- [Flaws in the Revamped Medicare Part D Plan Finder Could Result in Higher Than Expected Costs for Seniors](https://aimedalliance.org/flaws-in-the-revamped-medicare-part-d-plan-finder-could-result-in-higher-than-expected-costs-for-seniors/) - The Centers for Medicare & Medicaid Services (CMS) recently made changes to the Medicare Part D plan finder tool, which is designed to assist enrollees select their Medicare plan during the open enrollment period. These changes altered how the available plans are displayed to prospective enrollees, and it now sorts plans by how expensive their
- [Following Fall Regulatory Agenda, CMS Will Seek Input on Necessity of Medicaid Transportation Benefit](https://aimedalliance.org/following-fall-regulatory-agenda-cms-will-seek-input-on-necessity-of-medicaid-transportation-benefit/) - On November 20, 2019, the Centers for Medicare & Medicaid Services (CMS) released its Fall regulatory agenda, which indicated that the agency will release a request for information (RFI) next month. This RFI will solicit feedback on the necessity of a regulation that requires state Medicaid programs to provide transportation for enrollees to non-emergency medical
- [Lawsuit Filed in Michigan Challenging the Legality of Medicaid Work Requirements](https://aimedalliance.org/lawsuit-filed-in-michigan-challenging-the-legality-of-medicaid-work-requirements/) - Michigan’s Medicaid program is scheduled to implement work requirements on January 1, 2020, but those plans could be put on hold as advocates have filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) in the U.S. District Court for the District of Columbia, challenging the legality of the work requirements. Just as
- [Short-Term Plans Exclude Coverage for Pre-Existing Conditions, Leaving Enrollees Without Adequate Protection](https://aimedalliance.org/short-term-plans-exclude-coverage-for-pre-existing-conditions-leaving-enrollees-without-adequate-protection/) - When Peter LaFrance went to the hospital for congestive heart failure and type 2 diabetes, he was left with over $35,000 in medical bills that his insurer refused to cover. His health coverage, obtained through Golden Rule, which is a subsidiary of UnitedHealth Care, was a short-term, limited-duration health plan. These types of health plans
- [FDA Indicates that CBD Is Not Yet Generally Recognized as Safe](https://aimedalliance.org/fda-indicates-that-cbd-is-not-yet-generally-recognized-as-safe/) - Stakeholders and advocates have been waiting for the U.S. Food and Drug Administration (FDA) to decide whether cannabidiol (CBD) can be included in food in dietary supplements, with some wondering whether the agency will use the Generally Recognized as Safe (GRAS) affirmation process to allow for CBD to be used in food. On Monday, November
- [Legislative Leaders in Michigan Refuse to Delay Medicaid Work Requirements](https://aimedalliance.org/legislative-leaders-in-michigan-refuse-to-delay-medicaid-work-requirements/) - Beginning on January 1, 2020, most adults in Michigan between the ages of 19 and 61 who are participating in the Healthy Michigan program will have to prove 20 hours of workforce engagement per week to maintain their Medicaid coverage. In response to the upcoming implementation of the work requirements policy, Michigan’s Gov. Gretchen Whitmer
- [Aimed Alliance Joins 19 Advocacy Organizations Recommending the Enactment of PBM Legislation in NY](https://aimedalliance.org/aimed-alliance-joins-19-advocacy-organizations-recommending-the-enactment-of-pbm-legislation-in-ny/) - On December 5, 2019, Aimed Alliance joined a coalition of advocacy organizations in a letter addressed to New York Gov. Andrew Cuomo, requesting that he sign into law a bill that would give the state additional authority to license and regulate pharmacy benefit managers (PBMs). This advocacy effort was led by led by the Pharmacists
- [New Study Finds that MA Plans Are Offering Supplemental Benefits, But Funding Remains a Challenge](https://aimedalliance.org/new-study-finds-that-ma-plans-are-offering-supplemental-benefits-but-funding-remains-a-challenge/) - Following the Centers for Medicare & Medicaid Services’ (CMS) Medicare Advantage (MA) and Part D Call Letter that was issued on April 1, 2019, Medicare Advantage plans have begun offering supplemental benefits for the first time. Some of the supplemental benefits being offered include pest control, companionship programs, and transportation benefits. These supplemental benefits are
- [NAIC Cautions CMS Against Establishing Standards for Selling Health Insurance Across State Lines](https://aimedalliance.org/naic-cautions-cms-against-establishing-standards-for-selling-health-insurance-across-state-lines/) - On Dec. 5, 2019, the National Association of Insurance Commissioners (NAIC) issued a letter to the Centers for Medicare & Medicaid Services (CMS), requesting that the agency not move forward with plans to establish standards for interstate compacts for the sale of health insurance across state lines. CMS has moved to establish these standards because
- [Aimed Alliance Releases New Report, Exploring Employer Priorities When Selecting Health Benefits](https://aimedalliance.org/aimed-alliance-releases-new-report-exploring-employer-priorities-when-selecting-health-benefits/) - On December 13, 2019, Aimed Alliance released a new report titled “Costly Considerations: An Analysis of Employer Priorities When Selecting Health Benefits,” which explores the factors that employers prioritize when selecting health benefits for their employees. Based on a comprehensive survey of over 300 HR professionals, this report found that HR professionals place the highest
- [Kentucky Governor Withdraws Controversial Application to Implement Medicaid Work Requirements](https://aimedalliance.org/kentucky-governor-withdraws-controversial-application-to-implement-medicaid-work-requirements/) - On December 16, 2019, Kentucky Gov. Andy Beshear withdrew the state’s application to implement work requirements in its Medicaid program. The application was originally approved by the Centers for Medicare & Medicaid Services (CMS) in January of 2018, which made Kentucky the first state to receive approval to implement the divisive work requirements policy. The
- [CMS Grants Approval for South Carolina to Implement Medicaid Work Requirements](https://aimedalliance.org/cms-grants-approval-for-south-carolina-to-implement-medicaid-work-requirements/) - On Dec. 12, 2019, the Centers for Medicare & Medicaid Services (CMS) approved two Medicaid waivers for South Carolina. The first waiver extends Medicaid eligibility to parents and caretakers between 62 and 100 percent of the Federal poverty level, those who are chronically homeless, and those in need of treatment for substance use disorder. The
- [Congress Declines to Act on Surprise Medical Bills in 2019](https://aimedalliance.org/congress-declines-to-act-on-surprise-medical-bills-in-2019/) - On Dec. 16, 2019, Congress released an end-of-year appropriations bill that did not include legislative fixes for surprise out-of-network medical bills or the rising cost of prescription drugs. The bill did include a five-month extension of Medicare and Medicaid policies, which will give Congress an opportunity to pass legislation on surprise billing and prescription drug
- [Developers of Electronic Health Record Systems Allegedly Gamed the System to Receive Millions in Federal Subsidies](https://aimedalliance.org/developers-of-electronic-health-record-systems-allegedly-gamed-the-system-to-receive-millions-in-federal-subsidies/) - In 2018, a whistleblower lawsuit filed against Community Health Systems (CHS) and Medhost showed that flaws in the health system’s electronic health record (EHR) software may have exposed patients to health risks. The suit alleges that CHS had fraudulently obtained millions of dollars in federal subsidies by covering up flaws in the software that pose
- [Enrollment in ACA Plans Keeps Pace with Previous Years](https://aimedalliance.org/enrollment-in-aca-plans-keeps-pace-with-previous-years/) - The Centers for Medicare & Medicaid Services (CMS) recently announced that enrollment in health plans through the Patient Protection and Affordable Care Act’s (ACA) insurance marketplaces reached 8.3 million this year. This represents a 1.8 percent reduction from the 8.5 million people who enrolled in a plan through the insurance marketplaces last year. This figure
- [Aimed Alliance Joins 19 Advocacy Organizations Opposing Tennessee’s Proposed Closed Formulary](https://aimedalliance.org/aimed-alliance-joins-19-advocacy-organizations-opposing-tennessees-proposed-closed-formulary/) - On Dec. 24, 2019, Aimed Alliance joined a coalition of advocacy organizations in a letter to the Centers for Medicare & Medicaid Services (CMS), requesting that the agency reject Tennessee’s proposed amendment to the state’s TennCare Demonstration. This amendment proposes to implement a closed formulary in the state’s Medicaid program, which would allow the value
- [BenefitsPRO Article Features New Aimed Alliance Report on Employers and Health Benefits](https://aimedalliance.org/benefitspro-article-features-new-aimed-alliance-report-on-employers-and-health-benefits/) - On December 18, 2019, BenefitsPRO published an article that featured Aimed Alliance’s recently published report titled “Costly Considerations: An Analysis of Employer Priorities When Selecting Health Benefits,” which discusses what employers and HR professionals prioritize when selecting health benefits for their employees. This article called attention to the burdens that utilization management strategies place on
- [National Academy of Medicine Issues a Report on Clinician Burnout](https://aimedalliance.org/national-academy-of-medicine-issues-a-report-on-clinician-burnout/) - On October 23, 2019, the National Academy of Medicine issued a report on clinician burnout, which assessed the scope of burnout among health care practitioners and the aggregate burden that it places on the U.S. health care system. The report found that between 35 and 54 percent of doctors and nurses and up to 60
- [Indiana Suspends Enforcement of Medicaid Work Requirements](https://aimedalliance.org/indiana-suspends-enforcement-of-medicaid-work-requirements/) - On October 31, 2019, the Indiana Family and Social Services Administration (FSSA) announced that enforcement of the state’s Medicaid work requirements will be suspended, pending a legal challenge that has been brought against the state in federal court. This follows a similar announcement from Arizona on October 17, 2019. The suit, Rose v. Azar, was
- [Georgetown Center for Children and Families Notes Coverage Losses in New Report on Children’s Health Coverage](https://aimedalliance.org/georgetown-center-for-children-and-families-notes-coverage-losses-in-new-report-on-childrens-health-coverage/) - On October 30, 2019, the Georgetown University’s Center for Children and Families issued a new report that analyzes coverage trends based on survey data from the U.S. Census Bureau. This report discusses how health coverage for children fluctuated between 2016 and 2018, which coincided with congressional attempts to repeal and replace the Patient Protection and
- [Indiana Gastroenterologist Authors Op-ed Decrying the Inefficiencies of Prior Authorization](https://aimedalliance.org/indiana-gastroenterologist-authors-op-ed-decrying-the-inefficiencies-of-prior-authorization/) - On October 22, William E. Bennett Jr., a gastroenterologist based in Indiana, authored an opinion piece about prior authorization that was published by Houma Today. This article explains the process that is required to obtain a prior authorization approval from an insurance company and how long the process typically takes. Dr. Bennett also explains how
- [CMS Administrator Announces the Creation of the Office of Burden Reduction](https://aimedalliance.org/cms-administrator-announces-the-creation-of-the-office-of-burden-reduction/) - On September 30, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to promote efficiency within the Medicare and Medicaid programs. A significant portion of the final rule is designed to reduce or eliminate needless paperwork that often burdens health care providers. The rule is scheduled to take effect 60 days
- [Federal Lawmakers Reintroduce Legislation to Expand Medicare’s Coverage of Telehealth Services](https://aimedalliance.org/federal-lawmakers-reintroduce-legislation-to-expand-medicares-coverage-of-telehealth-services/) - On October 30, 2019, a bipartisan group of lawmakers who are members of the Congressional Telehealth Caucus reintroduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019. The primary sponsors of the bill are Senators Brian Schatz, Roger Wicker, Ben Cardin, John Thune, Mark Warner, and Cindy Hyde-Smith.
- [The Office of Management and Budget is Reviewing a Regulation to Allow Drug Importation](https://aimedalliance.org/the-office-of-management-and-budget-is-reviewing-a-regulation-to-allow-drug-importation/) - On November 1, 2019, the Office of Management and Budget (OMB) received a proposed rule that would allow the importation of prescription drugs from outside the United States. The full details of the proposal are not yet available, but the U.S. Food and Drug Administration (FDA) released a preliminary plan earlier this year. OMB’s receipt
- [Aimed Alliance Issues Letter of Support for AMA Resolutions on Step Therapy and Copay Accumulators](https://aimedalliance.org/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
- [Can States Adequately Protect Consumers if the ACA is Overturned?](https://aimedalliance.org/can-states-adequately-protect-consumers-if-the-aca-is-overturned/) - Concerns that the Patient Protection and Affordable Care Act (ACA) may be struck down by the court have prompted many states to take precautions to protect their citizens who are at risk of losing coverage or valuable patient protections. Some states have enacted legislation codifying key parts of the ACA, yet only three states have
- [Copay Accumulator Toolkit for Employers](https://aimedalliance.org/copay-accumulator-toolkit-for-employers/) - The following Aimed Alliance digital advocacy toolkit includes engaging digital resources that you and your organization can share to help raise awareness about the impact that copay accumulator adjustment programs can have and the need to strike a balance between promoting a healthy workforce and managing costs: Employers Beware: Understanding the Costs and Liability Risks
- [Whistleblower Reveals Google Engaging in Suspicious Activity Involving Confidential Medical Records](https://aimedalliance.org/whistleblower-reveals-google-engaging-in-suspicious-activity-involving-confidential-medical-records/) - A whistleblower from Google leaked video footage revealing that the company’s project Nightingale has been collecting confidential medical records from an estimated nearly 50 million Americans. To obtain the medical records, Google partnered with the second-largest U.S. healthcare provider, Ascension. The medical records held by Ascension were protected under the Health Insurance Portability and Accountability
- [Aimed Alliance Comments on the Lower Health Care Costs Now Act of 2019](https://aimedalliance.org/aimed-alliance-comments-on-the-lower-health-care-costs-now-act-of-2019/) - On November 8, 2019, Aimed Alliance submitted a comment to congressional leaders regarding the Lower Health Care Costs Now Act of 2019, which is a proposal moving through the U.S. House of Representatives that attempts to address the rising costs of prescription drugs. This letter supported the legislation's provision that would implement a $2,000 cap
- [CMS Issues Guidance Allowing States to Implement Health-Contingent Wellness Programs](https://aimedalliance.org/cms-issues-guidance-allowing-states-to-implement-health-contingent-wellness-programs/) - On Monday, September 30, the Centers for Medicare and Medicaid Services (CMS) announced that the agency will allow states to request to implement health-contingent wellness programs in their individual markets. As part of a demonstration project, CMS will allow 10 states to apply for permission to implement these programs. Health-contingent wellness programs require participants to
- [Along State Lines: Medicaid Expansion](https://aimedalliance.org/along-state-lines-medicaid-expansion/) - State borders have become dividing lines that determine whether many Americans have access to Medicaid health insurance coverage. As of 2019, 36 states have expanded Medicaid to include more low-income individuals with household incomes up to 138 percent of the federal poverty level through the Affordable Care Act, ballot measures, legislation, or Medicaid Waiver applications.
- [Aimed Alliance Opinion Piece on Nonmedical Switching Published in the Columbus Dispatch](https://aimedalliance.org/aimed-alliance-opinion-piece-on-nonmedical-switching-published-in-the-columbus-dispatch/) - On October 8, 2019, the Columbus Dispatch published an opinion piece authored by Aimed Alliance Staff Attorney John A. Wylam on nonmedical switching in Ohio health systems. While the term “nonmedical switching” typically refers to an insurance practice, health systems also engage in nonmedical switching by instructing their practitioners to stop prescribing certain medications for
- [Aimed Alliance Submits Petition for Rulemaking to HHS, DOL, and Treasury](https://aimedalliance.org/aimed-alliance-submits-petition-for-rulemaking-to-hhs-dol-and-treasury/) - On October 9, 2019, Aimed Alliance, a non-profit organization that works to protect and enhance the rights of consumers and providers, submitted a petition for rulemaking to the U.S. Department of Health and Human Services (HHS), the U.S. Department of Labor, and the U.S. Department of the Treasury (collectively, the Departments) to ask the agencies
- [HHS Encourages Value-Based Arrangements with New Exceptions to the Stark Law and Anti-Kickback Statute](https://aimedalliance.org/hhs-encourages-value-based-arrangements-with-new-exceptions-to-the-stark-law-and-anti-kickback-statute/) - On October 9, 2019, the U.S. Department of Health and Human Services (HHS) released two proposed rules that aim to modernize the Anti-Kickback Statute and the Stark Law that allow greater utilization of value-based arrangements and encourage care coordination. The Anti-Kickback Statute is a federal law that prohibits the exchange of anything of value for
- [HHS Releases New Prescribing Guidelines for Opioids to Address Treatment Abandonment](https://aimedalliance.org/hhs-releases-new-prescribing-guidelines-for-opioids-to-address-treatment-abandonment/) - On October 10, 2019, the U.S. Department of Health and Human Services (HHS) issued new opioid prescribing guidelines for patients with chronic pain. These guidelines offer clinical considerations for prescribers who feel it is appropriate to taper a patient off their long-term opioid analgesic medications, which has become a concern for the nearly 100 million
- [Aimed Alliance Comments on ICER's Proposed 2020 Value Assessment Framework](https://aimedalliance.org/aimed-alliance-comments-on-icers-proposed-2020-value-assessment-framework/) - On October 15, 2019, Aimed Alliance submitted a comment to the Institute of Clinical and Economic Review (ICER) regarding its Proposed Changes to the 2020 Value Assessment Framework. Aimed Alliance thanked ICER for its stated commitments to the inclusion of real-world evidence and the patient perspective in its Value Assessment Framework, but explained our concern
- [Aimed Alliance and NORM Publish an Open Enrollment Brochure for Medicare](https://aimedalliance.org/aimed-alliance-and-norm-publish-an-open-enrollment-brochure-for-medicare/) - Today, Aimed Alliance and the National Organization of Rheumatology Managers (NORM) jointly released a new brochure intended to assist health care consumers enroll in a Medicare plan. Our brochure, “Medicare Open Enrollment: Understanding Your Medicare Plan and Your Cost-Sharing Responsibilities” includes comprehensive guidance for enrolling in a Medicare plan during the Open Enrollment Period, which
- [Medicare Advantage Plan Sanctioned by CMS for Failing to Comply with Medical Loss Ratio](https://aimedalliance.org/medicare-advantage-plan-sanctioned-by-cms-for-failing-to-comply-with-medical-loss-ratio/) - On October 16, 2019, a Medicare Advantage plan administered by UnitedHealthcare was sanctioned by the Centers for Medicare & Medicaid Services (CMS) for failing to comply with medical loss ratio (MLR), which set a threshold for how much money a health plan must spend towards enrollees’ health care. Medicare Advantage plans must maintain an MLR
- [Federal District Court Vacates Sections of the ACA’s Nondiscrimination Rule](https://aimedalliance.org/federal-district-court-vacates-sections-of-the-acas-nondiscrimination-rule/) - On October 15, 2019, Judge Reed O’Connor issued a ruling in Franciscan Alliance v. Azar, which has been pending since 2016. In this ruling, Judge O’Connor vacated parts of the Affordable Care Act’s Sec. 1557, which prohibited health plans from discriminating on the basis of gender identity and termination of pregnancy because they violated the
- [Arizona Suspends Proposal to Implement Medicaid Work Requirements](https://aimedalliance.org/arizona-suspends-proposal-to-implement-medicaid-work-requirements/) - On October 17, 2019, Arizona sent a letter to the Centers for Medicare & Medicaid Services (CMS), notifying the agency that the state will not be implementing work requirements in its Medicaid program because of the several legal challenges that have been brought against other states that have attempted to implement this policy. Arizona had
- [Aimed Alliance and NORM Publish Fact Sheet on Medicare vs. Medicare Advantage](https://aimedalliance.org/aimed-alliance-and-norm-publish-fact-sheet-on-medicare-vs-medicare-advantage/) - Aimed Alliance and the National Organization of Rheumatology Managers (NORM) recently collaborated to create a fact sheet that explains the differences between Medicare and Medicare Advantage plans, with details on how cost-sharing can differ between these types of plans. Do you or a loved one need assistance understanding what your cost-sharing responsibilities and overall costs
- [Aimed Alliance and NORM Release an Open Enrollment Brochure for Employers and HR Professionals](https://aimedalliance.org/aimed-alliance-and-norm-release-an-open-enrollment-brochure-for-employers-and-hr-professionals/) - Today, Aimed Alliance and the National Organization for Rheumatology Managers (NORM) published a brochure for employers and HR professionals. This brochure, titled "Open Enrollment: Selecting Benefits for Your Employees to Protect Their Health," is intended to assist employers and HR professionals during the benefits selection process and to provide them with objective information about health
- [CMS Announces Reduced Marketplace Premiums for 2020   ](https://aimedalliance.org/cms-announces-reduced-marketplace-premiums-for-2020/) - On October 22, 2019, the Centers for Medicare & Medicaid Services (CMS) announced that average premiums for marketplace plans will be 4 percent lower in 2020 and that 20 percent more insurers are participating in the Federal Health Insurance Exchange platform compared to the previous year. The total number of participating insurers is now 175,
- [FDA Approves Breakthrough Therapy for Cystic Fibrosis](https://aimedalliance.org/fda-approves-breakthrough-therapy-for-cystic-fibrosis/) - On October 21, 2019, the U.S. Food and Drug Administration (FDA) approved a new medication to treat cystic fibrosis. The new treatment is approved for cystic fibrosis patients age 12 and older who have at least one F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which represents roughly 90 percent of cystic
- [HealthSherpa Publishes Health Plan Premiums for 2020 Before Healthcare.gov](https://aimedalliance.org/healthsherpa-publishes-health-plan-premiums-for-2020-before-healthcare-gov/) - On October 22, 2019, the HealthSherpa website published rate information for health plans that will be sold during the upcoming open enrollment period, which allows consumers to review the premiums that they can expect to pay for health insurance in the coming year. This occurred on the same day that the Centers for Medicare &
- [Consumers Satisfied with ACA Plans, but Lack Knowledge on Enrollment Process](https://aimedalliance.org/consumers-satisfied-with-aca-plans-but-lack-knowledge-on-enrollment-process/) - A national poll of health insurance marketplace consumers and uninsured consumers eligible to enroll, conducted by Get America Covered, identified a growing demand for health coverage among both insured and uninsured populations. The survey also revealed that statements made by the Trump Administration have contributed to misinformation among consumers about the coverage that is available
- [Pennsylvania Gastroenterologist Authors Op-ed in Support of Nonmedical Switching Legislation](https://aimedalliance.org/pennsylvania-gastroenterologist-authors-op-ed-in-support-of-nonmedical-switching-legislation/) - On August 13, 2019, Dr. Ralph McKibbin, a gastroenterologist who practices out of Altoona, PA, authored an op-ed in support of a nonmedical switching bill that is currently being considered by the Pennsylvania legislature. In this piece, Dr. McKibbin elaborates on how nonmedical switching can harm patients and how the practice often interferes with managing
- [Federal Judge Finalizes CVS-Aetna Merger, But Critics Wary of Harm to Consumers](https://aimedalliance.org/federal-judge-finalizes-cvs-aetna-merger-but-critics-wary-of-harm-to-consumers/) - On September 4, 2019, U.S. District Court Judge Richard J. Leon formally approved the merger between the health care giants CVS and Aetna, but will consumers experience any benefits as a result of the deal? Some critics, including the American Medical Association (AMA), the American Antitrust Institute (AAI), and the U.S. Public Interest Research Group
- [Speaker Pelosi Releases Draft Drug Pricing Legislation, Embracing International Pricing Index](https://aimedalliance.org/speaker-pelosi-releases-draft-drug-pricing-legislation-embracing-international-pricing-index/) - On September 10, 2019, House Speaker Nancy Pelosi released draft legislation that combines several different approaches for addressing the cost of prescription drugs. Interestingly, the legislation includes an international pricing mechanism that would require the federal government to negotiate prices for the 250 most expensive medications. This price negotiation would incorporate prices paid by other
- [New Data from the U.S. Census Bureau Reveals a Decline in Insurance Enrollment](https://aimedalliance.org/new-data-from-the-u-s-census-bureau-reveals-a-decline-in-insurance-enrollment/) - On September 10, 2019, the U.S. Census Bureau released a report that analyzed health insurance coverage in the United States for 2018. This report shows how the number of uninsured Americans rose to 8.5 percent of the population – an increase of 1.9 million people or 0.5 percent. In the aggregate, 27.5 million Americans were
- [Aimed Alliance Releases 2018 Annual Report](https://aimedalliance.org/aimed-alliance-releases-2018-annual-report/) - The past year was transformative for Aimed Alliance, a non-profit health policy organization that seeks to protect and enhance the rights of health care consumers and providers. In our 2018 Annual Report, you can review the progress we made over the course of the year and gain insight into what we've done in 2019. In
- [Aimed Alliance Sends Nonmedical Switching Sign-on Letter to BCBS of Michigan](https://aimedalliance.org/aimed-alliance-sends-nonmedical-switching-sign-on-letter-to-bcbs-of-michigan/) - On September 10, 2019, Aimed Alliance was joined by 9 other advocacy organizations to request that the Blue Cross Blue Shield of Michigan health plan end its nonmedical switching practices. This complaint arose as a result of the health plan's decision to transition patients with conditions like rheumatoid arthritis, ankylosing spondylitis, psoriasis, and Crohn's disease
- [Funding for Behavioral Health Clinics Set to Expire](https://aimedalliance.org/funding-for-behavioral-health-clinics-set-to-expire/) - This Friday, September 13, 2019, funding for certified community behavioral health clinics (CCBHCs) will expire unless Congress extends funding. These clinics provide vital evidence-based services, including 24-hour crisis care, managed detox, medication-assisted treatment (MAT) for substance use disorder (SUD), and care coordination with physical health care services. If funding expires, people are at risk of
- [Federal Agency Initiates First Enforcement Action Over Inaccessible Medical Records](https://aimedalliance.org/federal-agency-initiates-first-enforcement-action-over-inaccessible-medical-records/) - Bayfront Health of St. Petersburg, FL became the first HIPAA-covered entity to be sanctioned by U.S. Health and Human Services Office of Civil Rights (OCR) under the agency’s new Right to Access Initiative. This initiative was launched earlier this year to improve the ability of patients to access their medical records and to increase compliance
- [CVS Health to Settle Lawsuit for Revealing HIV Status of Over 4,500 Patients](https://aimedalliance.org/cvs-health-to-settle-lawsuit-for-revealing-hiv-status-of-over-4500-patients/) - Under the recently proposed agreement, CVS Health is slated to pay $4.35 million to settle claims that it divulged protected health information of 4,500 Ohio residents regarding their HIV diagnosis. In March 2018, three unidentified plaintiffs filed a federal class action lawsuit in Ohio alleging that CVS Health revealed the HIV status of over 4,500
- [HHS, DOL, and Treasury Release Additional Guidance on Mental Health Parity](https://aimedalliance.org/hhs-dol-and-treasury-release-additional-guidance-on-mental-health-parity/) - On September 5, 2019, the U.S. Department of Health and Human Services, Department of Labor, and Treasury jointly issued a guidance document titled FAQs About Mental Health And Substance Use Disorder Parity Implementation and the 21st Century Cures Act Part 39. This document contains the government’s responses to frequently asked questions regarding the implementation of
- [Whole Foods Excludes 1,900 Part-Time Workers from Health Benefits](https://aimedalliance.org/whole-foods-excludes-1900-part-time-workers-from-health-benefits/) - On September 12, 2019, Business Insider reported that Whole Foods will be changing their benefits structure for part-time employees, beginning on January 1, 2020. Despite being owned by Amazon, Inc., which has been described as “the most valuable company in the world,” Whole Foods will no longer allow part-time employees who work less than 30
- [The Precision Medicine Group Discusses Copay Accumulators, References Aimed Alliance Report](https://aimedalliance.org/the-precision-medicine-group-discusses-copay-accumulators-references-aimed-alliance-report/) - Following the enactment of a new law in Virginia that regulates copay accumulator programs, the Precision Medicine Group published an article that discusses copay accumulator and copay maximizer policies in-depth. This article, titled Virginia Passes Law Barring Accumulators; Programs’ Use Rises, provides an overview of how these health insurance policies function and how they can
- [Consumer Technology Association Releases Consensus Guidelines on Health Data Privacy](https://aimedalliance.org/consumer-technology-association-releases-consensus-guidelines-on-health-data-privacy/) - On September 12, 2019, the Consumer Technology Association (CTA) released a set of standards for health data privacy that were jointly developed by industry stakeholders. While the guidelines are voluntary, they contain sensible policies regarding the collection, use, and sharing of data generated from health and wellness devices, applications, websites, and other digital tools. These
- [Congressional Leaders Pressure FDA to Act Quickly on CBD Regulation](https://aimedalliance.org/congressional-leaders-pressure-fda-to-act-quickly-on-cbd-regulation/) - Earlier this month, Senate Majority Leader Mitch McConnell moved to include report language in the FY 2020 spending bill that would require the U.S. Food and Drug Administration (FDA) to hasten its progress towards regulating the market for cannabidiol products (CBD). If enacted as part of the annual spending bill, the language would: Require the
- [Aimed Alliance Submits Testimony on Cardiovascular Comparative Effectiveness Study](https://aimedalliance.org/aimed-alliance-submits-testimony-on-cardiovascular-comparative-effectiveness-study/) - On September 26, 2019, Aimed Alliance delivered oral testimony on the Institute for Clinical and Economic Review’s (ICER) Evidence Report on Additive Therapies for Cardiovascular Disease: Effectiveness and Value. We thanked ICER for deeming both icosapent ethyl and rivaroxaban to be cost effective and responsibly priced. We also highlighted our concerns that (1) the Evidence
- [Aimed Alliance Submits Comment to HHS in Response to Proposed Rule on Hospital Transparency](https://aimedalliance.org/aimed-alliance-submits-comment-to-hhs-in-response-to-proposed-rule-on-hospital-transparency/) - On September 27, 2019, Aimed Alliance submitted a comment to the U.S. Department of Health and Human Services (HHS) in response to the agency’s proposal to require hospitals to publish additional information about their prices to allow consumers to make better price comparisons for health services between different hospitals and health systems. The proposed rule,
- [Exorbitant Health Care Costs Weigh on Both Employers and Employees](https://aimedalliance.org/exorbitant-health-care-costs-weigh-on-both-employers-and-employees/) - A recent survey of employers conducted by the Kaiser Family Foundation revealed that the cost of family health coverage has exceeded $20,000 per year. Employers typically cover most of this cost, but employees contribute an average of $6,000 towards premiums per year. However, employees are liable for additional cost-sharing if they utilize their health plan
- [Impeachment Hearings Threaten to Derail Drug Price Reform](https://aimedalliance.org/impeachment-hearings-threaten-to-derail-drug-price-reform/) - In a time of great partisan divide, both sides of the aisle seem to agree on one thing: it is time to lower prescription drug prices. Several different policy options have been offered that could lower prices, with controversial bills from both Speaker Pelosi and Sen. Grassley. Pelosi’s legislation has moved to an initial committee
- [Idaho Submits Waiver for Medicaid Work Requirements](https://aimedalliance.org/idaho-submits-waiver-for-medicaid-work-requirements/) - After a failed attempt to implement work requirements for Medicaid recipients, Idaho has resubmitted an amended work requirement waiver to the federal government. In order to change key parts of the Medicaid coverage, states must petition the U.S. Health and Human Services (HHS) for a waiver, which essentially allows a state to “waive” certain requirements
- [35 People Indicted for Fraudulently Billing Medicare $2 Billion for Genetic Tests](https://aimedalliance.org/35-people-indicted-for-fraudulently-billing-medicare-2-billion-for-genetic-tests/) - In response to one of the country’s largest health care fraud schemes, the Department of Justice (DOJ) indicted 35 individuals for improperly billing Medicare for unnecessary genetic tests. Individuals involved in the scheme include nine doctors, several telemedicine company recruiters, and lab technicians. Recruiters allegedly targeted elderly and disabled individuals with scare tactics, claiming that
- [HHS OIG Withdraws Policy Proposals from 1994 and 2002](https://aimedalliance.org/hhs-oig-withdraws-policy-proposals-from-1994-and-2002/) - The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) announced on August 2, 2019 that the agency is withdrawing two proposed rules that have been pending for several years. The first rule, originally proposed in 1994, would have allowed OIG to issue civil monetary penalties against hospitals if they knowingly
- [ACA Lawsuits Advance During Congressional Recess](https://aimedalliance.org/aca-lawsuits-advance-during-congressional-recess/) - Two rules from the Trump Administration issued pursuant to an October 2017 executive order have been challenged in federal district court in Washington, D.C., and those rulings are now being appealed in the D.C. Circuit Court of Appeals. Both rules seek to expand access to health plans that do not comply with the Patient Protection
- [What Do You Need to Know About Chronic Pancreatitis?](https://aimedalliance.org/what-do-you-need-to-know-about-chronic-pancreatitis/) - Chronic pancreatitis is a long-term progressive inflammatory disease of the pancreas that leads to permanent breakdown of the structure and function of the pancreas. The pancreas is a gland organ that is located in the abdomen, behind the stomach and below the ribcage. It specializes in producing important enzymes and hormones that help break down
- [Physician Groups Call for a Public Health Approach to Gun Violence](https://aimedalliance.org/physician-groups-call-for-a-public-health-approach-to-gun-violence/) - On August 7, 2019, a group of physicians published an article in The Annals of Internal Medicine calling for the implementation of practical policies that would reduce firearm injuries and death. The American Public Health Association (APHA) joined the authors in writing the article, which represents several national physician professional societies: the American Academy of
- [AAMC: Shortage of Primary Care Physicians Projected to Worsen](https://aimedalliance.org/aamc-shortage-of-primary-care-physicians-projected-to-worsen/) - According to new data from the Association of American Medical Colleges (AAMC), the nationwide primary care physician shortage could reach as high as 55,200 by 2032. If the provider shortage is not addressed, patients could experience longer wait times when scheduling future appointments, they may be unable to see their preferred providers, and they could
- [Aimed Alliance Responds to Trump Administration’s Proposed Changes to Sec. 1557 of the ACA](https://aimedalliance.org/aimed-alliance-responds-to-trump-administrations-proposed-changes-to-sec-1557-of-the-aca/) - On May 24, 2019, the Trump Administration proposed several changes to Sec. 1557 of the Patient Protection and Affordable Care Act (ACA), which was originally implemented in 2016 under the Obama Administration. Many of the proposed revisions have the effect of eliminating protections against discrimination on the basis of gender, pregnancy, sexual orientation, and gender
- [Federal Regulators Fail to Provide Effective Oversight of Medicaid Managed Care Programs](https://aimedalliance.org/federal-regulators-fail-to-provide-effective-oversight-of-medicaid-managed-care-programs/) - Following news reports that Medicaid managed care contractors are not properly delivering care to patients, Sen. Casey from Pennsylvania has written to the Centers for Medicare & Medicaid Services (CMS), urging the agency to investigate the matter. News reports have highlighted issues in California, Iowa, and Texas, where managed care companies refused to provide medically
- [Increased Insurer Participation in the Individual Market Benefits Consumers](https://aimedalliance.org/increased-insurer-participation-in-the-individual-market-benefits-consumers/) - While federal policymakers have spent years in heated debate over the future of the Patient Protection and Affordable Care Act (ACA), state legislatures have made steady progress shoring up their individual markets. Kaiser Health News reports that California, in particular, has seen great success persuading insurers to return to the state’s individual market by enacting
- [Aimed Alliance, Joined by 9 Advocacy Organizations, Urges the Cleveland Clinic to End Nonmedical Switching Practices](https://aimedalliance.org/aimed-alliance-joined-by-9-advocacy-organizations-urges-the-cleveland-clinic-to-end-nonmedical-switching-practices/) - On August 26, 2019, Aimed Alliance sent a sign-on letter to the Cleveland Clinic, requesting the health system to allow patients to stay on their medications. This letter follows up on an initial sign-on letter that Aimed Alliance sent to Cleveland Clinic in December 2018, requesting that the health system cease its nonmedical switching practices.
- [Health Care Stakeholders Identify Prior Authorization as Ripe for Reform](https://aimedalliance.org/health-care-stakeholders-identify-prior-authorization-as-ripe-for-reform/) - The Centers for Medicare & Medicaid Services (CMS) launched the Patients Over Paperwork Initiative in 2017, which seeks feedback from industry stakeholders on ways to reduce administrative burdens in health care and improving the patient experience. This year, CMS received over 560 comments in response to its request for information. The American Hospital Association (AHA)
- [Aimed Alliance Submits Comment to ICER Regarding Comparative Effectiveness Study on Cardiovascular Treatments](https://aimedalliance.org/aimed-alliance-submits-comment-to-icer-regarding-comparative-effectiveness-study-on-cardiovascular-treatments/) - On August 19, 2019, Aimed Alliance submitted a comment to the Institute for Clinical and Economic Review (ICER) regarding the organization’s comparative effectiveness review of icosapent ethyl and rivoroxaban for cardiovascular disease. Aimed Alliance cautioned against the practice of comparing these two treatments due to their distinct uses and mechanisms of action in the body:
- [Attorneys General Warn that Proposed Changes to Non-Discrimination Rule Could Violate the ACA and Administrative Procedure Act](https://aimedalliance.org/attorneys-general-warn-that-proposed-changes-to-non-discrimination-rule-could-violate-the-aca-and-administrative-procedure-act/) - In a comment letter to the U.S. Department of Health and Human Services (HHS), 22 attorneys general (AGs) have condemned the Trump Administration’s Proposed Rule to alter the Patient Protection and Affordable Care Act (ACA) non-discrimination provision, Section 1557. The AGs stated that the Proposed Rule directly conflicts with several provisions of the ACA and
- [Appreciating the Risks of “Bad Drug” Advertisements](https://aimedalliance.org/appreciating-the-risks-of-bad-drug-advertisements/) - Personal injury law firms often publish misleading advertisements that encourage viewers to join class action lawsuits against drug makers. These ads may contain disturbing imagery or logos of federal agencies that may heighten concern among viewers, frightening them out of taking their medication without first consulting with their health care provider. Aimed Alliance just published
- [FDA Issues Warning About Harmful Health Product](https://aimedalliance.org/fda-issues-warning-about-harmful-health-product/) - Earlier this month, the U.S. Food and Drug Administration (FDA) issued a consumer warning about a product marketed as a treatment for cancer, autism, and other medical conditions. Miracle Mineral Solution and similar products have been described online as 28 percent sodium chlorite in distilled water, with distributors suggesting consumers mix the solution with citric
- [Federal Agencies Walk Back Copay Coupon Protections](https://aimedalliance.org/federal-agencies-walk-back-copay-coupon-protections/) - Earlier this year, the Centers for Medicare & Medicaid Services (CMS) issued the 2020 Notice of Benefit and Payment Parameters (NBPP), which clarified when health plans can exclude the value of copay coupons from the calculation of enrollees’ annual limit on out-of-pocket costs. This rule would have allowed health plans to exclude the value of
- [Local Health Plans Help Contain Cost-Growth](https://aimedalliance.org/local-health-plans-help-contain-cost-growth/) - A recent brief published by the American Academy of Actuaries provides an analysis of the main drivers behind rising premiums as health plans prepare their rate filings for 2020. Some parts of the country could see premium increases as high as 8 percent, which mirrors the premium increases experienced in the 2019 rate filings. However,
- [Medical Record Apps Could Pose a Risk to Consumers](https://aimedalliance.org/medical-record-apps-could-pose-a-risk-to-consumers/) - New consumer applications are trying to make your medical records more accessible through your smartphone. Since 2000, Americans have had the right to access their medical records with the enactment of the Health Insurance Portability and Accountability Act. However, many providers and health systems have created barriers to accessing records such as requiring patients to
- [Woman Becomes First Person with Cystic Fibrosis to Give Birth to Triplets in the UK](https://aimedalliance.org/woman-becomes-first-person-with-cystic-fibrosis-to-give-birth-to-triplets-in-the-uk/) - Amy Sargeant, a 28-year-old UK woman defied the odds and gave birth to triplets at the end of last year, despite living with cystic fibrosis. Although Ms. Sargeant was only expected to live until age 30 when she met her partner Craig, the two have been together since they were teenagers and have always wanted
- [Commonwealth Fund Compares Care Rationing in the U.S. to Countries with Universal Coverage](https://aimedalliance.org/commonwealth-fund-compares-care-rationing-in-the-u-s-to-countries-with-universal-coverage/) - Critics of universal health coverage often cite “care rationing” as a reason not to move the United States towards a health care system that guarantees access to health care for all. Care rationing occurs when patients are forced to endure long wait times to see a health care provider or if they experience limited access
- [New Rules for Health Reimbursement Accounts Could Change How Employers Offer Health Coverage](https://aimedalliance.org/new-rules-for-health-reimbursement-accounts-could-change-how-employers-offer-health-coverage/) - Earlier this year, the Trump Administration published a final rule on Health Reimbursement Arrangements (HRAs), which could change the type of health coverage that people receive from their employer. Instead of offering coverage in a group health plan, the new rules allow companies to provide employees with tax-free funds that they can use to purchase
- [Journalist Shares Tips on How and When to Disclose a Disability to an Employer](https://aimedalliance.org/journalist-shares-tips-on-how-and-when-to-disclose-a-disability-to-an-employer/) - Lizz Schumer, a journalist for the New York Times, recently published an article that explores the complexities that surround living and working with a disability. This article called attention to the differences between the protections that the law provides for people living with disabilities and how the law is actually applied and enforced. Ms. Schumer
- [Senate Finance Committee Releases Draft Legislation to Address the Rising Cost of Prescription Drugs](https://aimedalliance.org/senate-finance-committee-releases-draft-legislation-to-address-the-rising-cost-of-prescription-drugs/) - On July 23, 2019, the Chairman and Ranking Member of the Senate Finance Committee, Sens. Chuck Grassley [R-GA] and Ron Wyden [D-OR], introduced the Prescription Drug Pricing Reduction Act (PDPRA) of 2019. This bipartisan legislation, if passed, would take several steps to reduce the cost of prescription drugs in the U.S. This bill is scheduled
- [New Aimed Alliance Report Finds Ohio Hospitals’ Non-Medical Switching Practices Harm Patients](https://aimedalliance.org/new-aimed-alliance-report-finds-ohio-hospitals-non-medical-switching-practices-harm-patients/) - According to a new report jointly published by Aimed Alliance and the Doctor-Patient Rights Project (DPRP), Ohio hospitals and health systems are forcing stable patients to use different treatments than those originally prescribed by their doctor. The report, titled A Forced Hand: How Ohio Health Systems’ Non-Medical Switching Policies Impact Physicians and Patients, found that
- [Cleveland.com Highlights Aimed Alliance Report on Nonmedical Switching in Ohio Hospitals](https://aimedalliance.org/cleveland-com-highlights-aimed-alliance-report-on-nonmedical-switching-in-ohio-hospitals/) - Following the publication of Aimed Alliance’s report, A Forced Hand: How Ohio Health Systems’ Non-Medical Switching Policies Impact Physicians and Patients, Cleveland.com published an article calling attention to the issue of Ohio hospitals requiring stable patients to switch their medications for cost-driven reasons. The report found that hospitals are removing medications from their internal formularies,
- [Kaiser Health News Releases Toolkit to Help Patients Understand Medical Bills](https://aimedalliance.org/kaiser-health-news-releases-toolkit-to-help-patients-understand-medical-bills/) - On July 25, 2019, Kaiser Health News released a toolkit to help people understand different aspects of medical billing. The toolkit includes comprehensive tips for navigating surprise medical bills, a glossary of common terminology, and example medical bills labeled for clarification. The resource also lists a number of suggested actions to take before seeking medical
- [FDA Announces Forthcoming Report on Regulatory Framework for CBD Products](https://aimedalliance.org/fda-announces-forthcoming-report-on-regulatory-framework-for-cbd-products/) - On July 23, 2019, the FDA announced that it expects to issue an update on the agency's progress formulating a regulatory framework for products containing cannabidiol (CBD) in the early fall. This announcement came following the FDA’s warning letter to the company Curaleaf for selling CBD products online without approval. The FDA is planning to
- [New Hampshire's Work Requirements Struck Down](https://aimedalliance.org/new-hampshires-work-requirements-struck-down/) - On Monday, July 29, U.S. District Court Judge James Boasberg struck down New Hampshire’s proposal to implement work requirements in the state’s Medicaid program, which had been approved by the Centers for Medicare & Medicaid Services (CMS) earlier this year. Pursuant to the state's Sec. 1115 waiver, New Hampshire would have required Medicaid beneficiaries to
- [EPIC Sends Letters to PBMs and Insurers Regarding PERT Coverage](https://aimedalliance.org/epic-sends-letters-to-pbms-and-insurers-regarding-pert-coverage/) - The Exocrine Pancreatic Insufficiency Coalition (EPIC), a coalition of likeminded organizations convened by Aimed Alliance to advocate on behalf of patients with Exocrine Pancreatic Insufficiency (EPI), sent thank you letters to insurers and pharmacy benefit managers (PBMs) last week. EPI is a condition that occurs when the human body is unable to provide an adequate
- [Trump Administration Releases Plan to Allow Prescription Drug Importation](https://aimedalliance.org/trump-administration-releases-plan-to-allow-prescription-drug-importation/) - On July 31, 2019, the Trump Administration issued a press release that outlined a forthcoming regulatory pathway that would enable the importation of prescription drugs. This announcement follows the Administration’s recent efforts to reduce the costs of prescription drugs, which have been unsuccessful, including the Administration’s proposed changes to the six protected classes, reforms to
- [Gastroenterologist Shares Tips for Recognizing Pancreatitis](https://aimedalliance.org/gastroenterologist-shares-tips-for-recognizing-pancreatitis/) - In this article published by WTOP, Dr. Mitesh Patel, a gastroenterologist at MedStar Washington Hospital Center, emphasizes the importance of knowing the symptoms, causes, and risk factors of chronic pancreatitis. Common symptoms include upper belly pain, nausea, unintended weight loss, and dehydration, while significant causes include drinking alcohol and smoking cigarettes. Dr. Patel also highlights
- [Pennsylvania Lawmakers Advance Sec. 1332 Waiver to Create a State-Based Health Insurance Exchange](https://aimedalliance.org/pennsylvania-lawmakers-advance-sec-1332-waiver-to-create-a-state-based-health-insurance-exchange/) - On June 11, 2019, the Pennsylvania House passed H.R. 3, which would move the state off the federal health exchange platform and would instead create a state-based exchange platform that would be less expensive to operate. The federal exchange platform charges a user fee comprised of 3.5 percent of plan premiums, which in 2019, accounted
- [New York Lawmakers Pass Nonmedical Switching Legislation, Send to Governor](https://aimedalliance.org/new-york-lawmakers-pass-nonmedical-switching-legislation-send-to-governor/) - On June 19, 2019, the New York Senate passed S. 2849, which would limit the ability for health plans to make formulary changes in the middle of the plan year. This legislation passed the New York House on June 17, 2019 and is currently awaiting Governor Cuomo’s signature. In March 2019, Aimed Alliance sent a
- [New England Journal of Medicine Study Shows Medicaid Work Requirements Do Not Result in Increased Employment Rates](https://aimedalliance.org/new-england-journal-of-medicine-study-shows-medicaid-work-requirements-do-not-result-in-increased-employment-rates/) - On June 19, researchers from Harvard published a study in the New England Journal of Medicine, which revealed how the Medicaid work requirements imposed in Arkansas have not been successful in lifting Medicaid beneficiaries out of poverty. Specifically, the study found that uninsured Arkansans in the 30 to 49 age group increased from 10.5 percent
- [Trump Administration Delays Proposal to Eliminate Transportation Benefit for Medicaid Beneficiaries](https://aimedalliance.org/trump-administration-delays-proposal-to-eliminate-transportation-benefit-for-medicaid-beneficiaries/) - The Centers for Medicare & Medicaid Services (CMS) has postponed its plan to roll back a regulation that requires state Medicaid programs to provide transportation to and from non-emergency medical appointments for beneficiaries who lack reliable transportation. The rule, which was originally slated to be released last month, is now expected to be released in
- [Trump Administration Proposes to Eliminate Protections for Non-English Speakers](https://aimedalliance.org/trump-administration-proposes-to-eliminate-protections-for-non-english-speakers/) - The Patient Protection and Affordable Care Act (ACA) regulations require health care organizations to notify patients of free translation services for the 15 most commonly spoken languages in each state. On May 24, 2019, the U.S. Department of Health and Human Services proposed to eliminate this requirement. When the requirement to offer translation services was
- [The Lower Health Care Costs Act Clears the Senate HELP Committee](https://aimedalliance.org/the-lower-health-care-costs-act-clears-the-senate-help-committee/) - On June 26, 2019, the Senate Health, Education, Labor & Pensions Committee passed the Lower Health Care Costs Act of 2019 with a bipartisan 20-3 vote. Aimed Alliance has been closely monitoring this legislation and is pleased to see it advance through the Senate. The Lower Health Care Costs Act contains several provisions that would
- [All Copays Count Coalition Sends Letter to State Insurance Commissioners](https://aimedalliance.org/all-copays-count-coalition-sends-letter-to-state-insurance-commissioners/) - On July 1, 2019, Aimed Alliance joined the All Copays Count Coalition in sending a letter to state insurance commissioners requested that they enforce a new federal rule that was finalized by the Centers for Medicare & Medicaid Services earlier this year regarding copay accumulator policies. The new rule will require that third-party financial assistance
- [Federal Court Invalidates Trump Administration’s Direct-to-Consumer Advertising Price Transparency Rule](https://aimedalliance.org/federal-court-invalidates-trump-administrations-direct-to-consumer-advertising-price-transparency-rule/) - On July 8, 2019, Judge Amit Mehta of the D.C. District Court ruled against the Trump Administration, holding that the U.S. Department of Health and Human Services (HHS) exceeded its authority when it promulgated a rule that would have required pharmaceutical manufacturers to include their products’ list prices in direct-to-consumer advertisements. However, Judge Mehta did
- [Trump Administration Withdraws Rebate Proposal](https://aimedalliance.org/trump-administration-withdraws-rebate-proposal/) - On July 10, 2019, the Trump Administration announced that the rebate rule, proposed in January, will not be finalized due to predictions that it would raise premiums in Medicare, in addition to the estimated $177 billion that the rule would cost the federal government over the next ten years. The proposed rule would have adjusted
- [High Costs Frustrate Attempts to Address HIV Through Preventative Care](https://aimedalliance.org/high-costs-frustrate-attempts-to-address-hiv-through-preventative-care/) - Reports have emerged of patients being unable to afford the regular lab tests and doctor visits that are required when taking medication that prevents HIV transmission. These costs can be insurmountable even if a patient is receiving assistance from the medication’s manufacturer to receive the medication for free. This can make it difficult for patients
- [Consumers Underutilize Appeals Processes When Insurers Deny Coverage](https://aimedalliance.org/consumers-underutilize-appeals-processes-when-insurers-deny-coverage/) - The Kaiser Family Foundation’s recent analysis of coverage appeals sheds light on the abundance of coverage denials that go unchallenged. This analysis revealed that only about 0.5 percent of coverage denials are appealed by consumers. This is alarming, as about half of appeals result in a coverage denial being overturned in favor of the consumer.
- [Aimed Alliance Submits a Comment to the FDA Regarding the Regulation of Hemp-Derived CBD Products](https://aimedalliance.org/aimed-alliance-submits-a-comment-to-the-fda-regarding-the-regulation-of-hemp-derived-cbd-products/) - In response to consumer confusion and certain health and safety risks involving food and supplement products containing cannabidiol (CBD), Aimed Alliance has called on the U.S. Food and Drug Administration (FDA) to take regulatory action. In a new comment, one-pager, and op-ed, Aimed Alliance asked the agency to improve marketing and labeling materials and to
- [What Do You Need to Know About Exocrine Pancreatic Insufficiency?](https://aimedalliance.org/what-do-you-need-to-know-about-exocrine-pancreatic-insufficiency/) - Exocrine pancreatic insufficiency occurs when the pancreas does not produce enough of the enzymes that aid digestion. This condition can lead to poor absorption of nutrients, weight loss, and a shortage of vitamins. Two of the main causes of exocrine pancreatic insufficiency (EPI) are cystic fibrosis and chronic pancreatitis. Symptoms are similar to other common
- [Pancreatic Cancer Action Network Provides Tips for Managing Exocrine Pancreatic Insufficiency](https://aimedalliance.org/pancreatic-cancer-action-network-provides-tips-for-managing-exocrine-pancreatic-insufficiency/) - Exocrine Pancreatic Insufficiency can cause ongoing digestive issues, such as stomach pain, weight loss, and diarrhea, but good nutritional care can improve quality of life for people living with this condition. In addition to taking a pancreatic enzyme replacement therapy (PERT), the Pancreatic Cancer Action Network's Chief Medical Officer Victoria Manax Rutson, MD shares eight
- [Pilot Study Suggests New Dosing Considerations for EPI Patients](https://aimedalliance.org/pilot-study-suggests-new-dosing-considerations-for-epi-patients/) - A study published on March 12, 2019, titled "Clinical validation of an evidence-based method to adjust Pancreatic Enzyme Replacement Therapy through a prospective interventional study in paediatric patients with Cystic Fibrosis" analyzed the relationship between pancreatic enzyme replacement therapy (PERT) dosing, patients' individual characteristics such as age, gender, and body mass index, as well as
- [An Update on Copay Accumulator Policies](https://aimedalliance.org/an-update-on-copay-accumulator-policies/) - On June 26, 2019, the Illinois legislature passed a copay accumulator bill and sent it to the governor for his signature. If Gov. Pritzker signs this legislation into law, Illinois will become the fourth state in the nation to enact a law that restricts the use of copay accumulator policies. These state laws go beyond
- [Federal District Court Upholds Short-Term Plan Rule](https://aimedalliance.org/federal-district-court-upholds-short-term-plan-rule/) - On Friday, July 19, federal District Court Judge Richard Leon sided with the Trump Administration in upholding the final rule that allows for the expansion of short-term health insurance plans. While the Obama Administration restricted the duration of short-term plans to three months without the option to renew, the Trump Administration’s final rule authorized these
- [Patient Power Discusses Care Planning and Financial Toxicity with a Financial Navigator](https://aimedalliance.org/patient-power-discusses-care-planning-and-financial-toxicity-with-a-financial-navigator/) - On May 30, 2019, Andrew Schorr from Patient Power interview Dan Sherman, who is a financial navigator that specializes in counseling cancer patients. Andrew and Dan discussed what happens when someone is diagnosed with cancer and how this impacts their personal finances, as well as touching on the prevalence of “financial toxicity” and how it
- [Aimed Alliance and Patient Power Partner Educate Individuals with Cancer About Coverage Appeals](https://aimedalliance.org/aimed-alliance-and-patient-power-partner-to-educate-individuals-with-cancer-about-coverage-appeals/) - In May 2019, Patient Power published a blog post authored by Aimed Alliance Staff Attorney John A. Wylam. This blog post discusses what patients can do if their insurer refuses to cover treatments and services for cancer care. If you have experienced a cancer diagnosis, be sure to review these educational materials so you learn
- [Aimed Alliance and Patient Power Partner Educate Individuals with Cancer About Employment Discrimination](https://aimedalliance.org/aimed-alliance-and-patient-power-partner-to-educate-individuals-with-cancer-about-employment-discrimination/) - In May 2019, Patient Power published a blog post authored by Aimed Alliance Staff Attorney John A. Wylam. This blog post discusses what employees can do if their employer discriminates against them due to their cancer diagnosis. If you have experienced a cancer diagnosis, be sure to review these educational materials so you know what
- [Aimed Alliance Sends Cautionary Letter to Blue Cross Blue Shield Regarding Nonmedical Switching](https://aimedalliance.org/aimed-alliance-sends-cautionary-letter-to-blue-cross-blue-shield-regarding-nonmedical-switching/) - On June 4, 2019, Aimed Alliance sent a letter to the Blue Cross Blue Shield Association responding to the insurer’s decision on September 26, 2018 to exclude several pancreatic enzyme replacement therapies (PERTs) from coverage in health plans offered to federal employees. Individuals with exocrine pancreatic insufficiency (EPI) rely on PERTs to replace the pancreatic
- [What’s the Plan for AHPs?](https://aimedalliance.org/whats-the-plan-for-ahps/) - On May 14, 2019, the Commonwealth Fund published a blog post authored by health policy expert Timothy S. Jost. This post provides a thorough analysis regarding the current legal status of association health plans following regulatory action from the Trump Administration and subsequent federal court decisions that impacted those regulations. This is an excellent resource
- [Aimed Alliance Study on Provider Burnout Referenced by Electronic Health Reporter](https://aimedalliance.org/aimed-alliance-study-on-provider-burnout-referenced-by-electronic-health-reporter/) - Last October, we published the findings from our survey of primary care providers that gauged their perceptions of the burdens that come with the practice of medicine. Among these burdens are requirements imposed on them by private insurers, like prior authorization and step therapy, which can interfere with patients’ and providers’ joint decision-making. The findings
- [Know Your Rights: Cystic Fibrosis](https://aimedalliance.org/cystic-fibrosis-epic-brochure/) - Cystic Fibrosis (CF) is a chronic, progressive, and rare genetic disease that causes the body to produce thick and sticky mucus that can cause damage to various organs, such as the lungs and the pancreas. It is typically diagnosed by age two. Continue reading.
- [Know Your Rights: Chronic Pancreatitis](https://aimedalliance.org/know-your-rights-chronic-pancreatitis/) - Chronic pancreatitis (CP) is gradual and worsening inflammation of the pancreas. This inflammation often results in permanent damage to the pancreas, the inability to digest food properly, and the inability to naturally produce insulin, which can lead to diabetes. Continue reading.
- [Know Your Rights: Exocrine Pancreatic Insufficiency](https://aimedalliance.org/know-your-rights-exocrine-pancreatic-insufficiency/) - Exocrine pancreatic insufficiency (EPI) is a condition that occurs when the human body is unable to provide an adequate supply of digestive enzymes. The shortage of digestive enzymes is commonly caused by other conditions that affect the pancreas, such as cystic fibrosis, pancreatic tumors, and chronic pancreatitis. Continue reading.
- [Aimed Alliance Joins PIPC Sign-on Letter Requesting Changes to ICER’s Value Assessment Framework](https://aimedalliance.org/aimed-alliance-joins-pipc-sign-on-letter-requesting-changes-to-icers-value-assessment-framework/) - On June 11, 2019, Aimed Alliance joined 37 other organizations in signing onto a letter to the Institute for Clinical and Economic Review (ICER), in response to the institute’s 2020 Value Assessment Framework. The letter urges ICER to focus on patients and people living with disabilities in its assessments and provides suggestions for ICER to
- [Aimed Alliance Joins MapRx Sign-on Letter Providing Recommendations on How to Improve Medicare Part D](https://aimedalliance.org/aimed-alliance-joins-maprx-sign-on-letter-providing-recommendations-on-how-to-improve-medicare-part-d/) - On June 6, 2019, Aimed Alliance joined 55 other organizations in signing onto a letter from the MAPRx Coalition to the House Ways and Means and the House Energy and Commerce Committees. The letter responded to draft legislation jointly introduced by the Committees that would impact Medicare Part D beneficiaries. The Coalition offers several recommendations
- [Pharmaceutical Manufacturers Sue Administration over Direct-to-Consumer Advertising Rule](https://aimedalliance.org/pharmaceutical-manufacturers-sue-administration-over-direct-to-consumer-advertising-rule/) - On Friday, June 14, three drug makers jointly filed suit against the Trump Administration, asserting that a proposed rule regarding direct-to-consumer advertising should be struck down for violating the First Amendment. The administration’s proposal, issued in October 2018, would require pharmaceutical manufacturers to include the wholesale acquisition cost of their products in television advertisements for
- [Senate Committee Releases an Updated Draft of the Lower Health Care Costs Act](https://aimedalliance.org/senate-committee-releases-an-updated-draft-of-the-lower-health-care-costs-act/) - On June 19, 2019, the Senate Help, Education, Labor & Pensions Committee released an updated version of the Lower Health Care Costs Act of 2019. The new version of the legislation includes additional funding for community health centers, provisions to strengthen mental health parity requirements, and provisions to address prescription drug costs. The mental health
- [Aimed Alliance Pushes Back Against Nonmedical Switching in Michigan](https://aimedalliance.org/aimed-alliance-pushes-back-against-nonmedical-switching-in-michigan/) - We recently learned that a Blue Care Network of Michigan is planning to rescind coverage of a medication on May 1, 2019, forcing stable patients to switch to a different treatment. Because this was done in the middle of the plan year, patients are unable to enroll in a different health plan that would cover
- [Oklahoma Governor Kevin Stitt Signs New Step Therapy Protections into Law](https://aimedalliance.org/oklahoma-governor-kevin-stitt-signs-new-step-therapy-protections-into-law/) - On Tuesday, April 26, 2019, Oklahoma governor signed SB 509 into law after the bill was unanimously approved by the legislature. This law creates new protections for patients when their insurers require them to go through step therapy. Step therapy occurs when a patient's insurer requires them to try alternative medications before paying for
- [Federal Action on Surprise Medical Bills Could Preempt State Laws](https://aimedalliance.org/federal-action-on-surprise-medical-bills-could-preempt-state-laws/) - The Congressional Research Service (CRS) released a report last week that analyzes the current legal landscape regarding surprise medical bills. This report also offers insights about how federal solutions could potentially interact with existing state laws. Central to this report was the notion that federal legislation could preempt existing state laws, which have been enacted
- [President Signs Medicaid Reform Package Into Law](https://aimedalliance.org/president-signs-medicaid-reform-package-into-law/) - On April 18, 2019, the President signed the Medicaid Services Investment and Accountability Act into law, which includes the Right Rebate Act. The Right Rebate Act was originally introduced in response to information uncovered during public hearings regarding a pharmaceutical manufacturer's pricing of their products that treat severe allergic reactions in 2016. During these hearings,
- [States Left Wondering About Status of Association Health Plans](https://aimedalliance.org/states-left-wondering-about-status-of-association-health-plans/) - On March 28, 2019, District Court Judge John Bates invalidated federal rules that allowed for the expansion of Association Health Plans (AHPs) because they served only to circumvent the requirements of the Patient Protection and Affordable Care Act. The federal government has not yet acted in response to the District Court's ruling, which has left
- [CMS Finalizes 2020 Notice of Benefit and Payment Parameters, Incorporating Stakeholder Feedback](https://aimedalliance.org/cms-finalizes-2020-notice-of-benefit-and-payment-parameters-incorporating-stakeholder-feedback/) - On April 18, 2019, the Centers for Medicare & Medicaid Services (CMS) released the final Notice of Benefit and Payment Parameters for the 2020 benefit year. We are glad to see that CMS has adopted several of our recommendations, including choosing to support patient access to treatment by not allowing mid-year formulary changes as was
- [New Hampshire Seeks to Defend Medicaid Work Requirements in Court](https://aimedalliance.org/new-hampshire-seeks-to-defend-medicaid-work-requirements-in-court/) - New Hampshire has filed an 1115 waiver with the Centers for Medicare & Medicaid Services, requesting to implement work requirements in the state's Medicaid program, but it has been challenged in court by Medicaid enrollees who would be impacted by the work requirements. On Thursday, April 25, lawyers representing the state of New Hampshire filed
- [Vermont Reacts to AHP Ruling](https://aimedalliance.org/vermont-reacts-to-ahp-ruling/) - Following the March 28, 2019 ruling that invalidated the regulations that allowed for the expansion of Association Health Plans (AHPs), Vermont insurance regulators have issued new guidance titled, "Impact of Federal District Court Ruling in State of New York v. United States Department of Labor on Vermont Association Health Plans." This guidance halts the approval
- [Aimed Alliance Joins Five Organizations in Opposing Colorado Medicaid Reimbursement Policy](https://aimedalliance.org/aimed-alliance-joins-5-organizations-in-opposing-colorado-medicaid-reimbursement-policy/) - Aimed Alliance has joined five organizations in voicing our opposition to a recently enacted Colorado Department of Healthcare Policy and Financing policy decision that will prohibit reimbursing health care providers for medication that remains in a single-use vial after it is administered to a patient. This policy impacts patients with complex conditions such as rheumatoid
- [Aimed Alliance Stands Up for Rural Nurse Practitioners](https://aimedalliance.org/aimed-alliance-stands-up-for-rural-nurse-practitioners/) - We recently learned of board-certified registered nurses and physician assistants practicing in the rural Midwest who have been unable to prescribe treatments to their patients due to discriminatory practices by a multi-state health insurer. These individuals are licensed under state law to prescribe medications to their patients, but the insurer has refused to cover the
- [Momentum Builds to Address Surprise Medical Bills Nationally](https://aimedalliance.org/momentum-builds-to-address-surprise-medical-bills-nationally/) - The Chairman and Ranking Member of the House Energy and Commerce Committee recently released a bipartisan discussion draft for legislation that would address the issue of surprise out-of-network medical bills. Surprise medical bills, also known as "balance bills,” arise when patients visit a hospital or health care provider that they think is in their insurance
- [Maryland Enacts Nonmedical Switching Law](https://aimedalliance.org/maryland-enacts-nonmedical-switching-law/) - On May 13, 2019, Maryland Gov. Larry Hogan signed SB 504 into law, which will require health plans sold in the state to establish a process that allows patients to receive a prescription medication or device after it has been removed from the health plan’s formulary. This law will protect patients from losing access to
- [Facebook Live Event Provides Patients with Tips on Managing their Cardiovascular Health](https://aimedalliance.org/facebook-live-event-provides-patients-with-tips-on-managing-their-cardiovascular-health/) - On May 14, 2019, the National Kidney Foundation and Amarin hosted an event on Facebook Live that focused on educating patients about managing their cardiovascular risk. This event features a conversation between a patient, a nephrologist, and a cardiologist, and is hosted by a broadcast journalist and medical reporter. The event also included a discussion
- [CMS Scraps Rule that Would Have Weakened Six Protected Classes](https://aimedalliance.org/cms-scraps-rule-that-would-have-weakened-six-protected-classes/) - Aimed Alliance is pleased to announce that CMS adopted our recommendations to preserve, rather than weaken, safeguards in place for Medicare’s Six Protected Classes. On May 16, 2019, CMS announced the final drug pricing rule for Medicare Advantage (MA) and Part D plans. The draft of this rule, originally issued in November 2018, would have
- [Aimed Alliance Joins Advocacy Organizations in Support of Connecticut Nonmedical Switching Legislation](https://aimedalliance.org/aimed-alliance-joins-advocacy-organizations-in-support-of-connecticut-nonmedical-switching-legislation/) - Connecticut legislators have been considering legislation that would prevent health plans from dropping medications from coverage or increasing their out-of-pocket costs after the plan year has begun. This legislation would prevent the nonmedical switching of stable patients. On May 20, 2019, Aimed Alliance joined a sign-on letter authored by the National Multiple Sclerosis Society, requesting
- [Trump Administration Releases Spring Regulatory Agenda, Delays Rulemaking](https://aimedalliance.org/trump-administration-releases-spring-regulatory-agenda-delays-rulemaking/) - Health care advocates have been anticipating the release of final regulations from the Trump Administration that could have sweeping impacts on the U.S. health care system. Those expectations were muted on May 22, 2019, when the administration released its Spring Regulatory Agenda, which includes an overview of forthcoming regulatory actions. The health policy community expected
- [Aimed Alliance Sends Letter of Gratitude to Director of TRICARE](https://aimedalliance.org/aimed-alliance-sends-letter-of-gratitude-to-director-of-tricare/) - When Congress passed the National Defense Authorization Act for Fiscal Year 2018 (NDAA), they gave the Department of Defense (DoD) new authority to exclude medications from TRICARE’s formulary. Following this, the agency took steps to exclude specific pancreatic enzyme replacement therapies (PERTs) from TRICARE’s formulary, which would prevent servicemembers from receiving coverage for them. PERTs
- [Aimed Alliance Offers Recommendations to Reduce the Cost of Health Care in the U.S.](https://aimedalliance.org/aimed-alliance-offers-recommendations-to-reduce-the-cost-of-health-care-in-the-u-s/) - On December 11th, 2018, the Chairman of the Senate Health, Education, Labor, & Pensions (HELP) Committee Sen. Lamar Alexander [R-TN] issued a letter asking for recommendations to reduce the cost of health care in the United States. Today, we responded to Sen. Alexander’s request with numerous recommendations for reducing the cost of health care in
- [Aimed Alliance Discusses Copay Accumulators in March Issue of HR News](https://aimedalliance.org/aimed-alliance-discusses-copay-accumulators-in-march-issue-of-hr-news/) - Employers are under constant pressure to reduce the health costs incurred by their employees. Recently, employers have opted to pursue this goal by implementing copay accumulator policies that restrict how payments made on behalf of enrollees count towards their cost-sharing responsibilities such as deductibles and maximum out-of-pocket costs. Aimed Alliance Counsel Stacey L. Worthy has
- [Insurers Offering New Types of Low-Cost Health Coverage, But Do They Adequately Protect Consumers?](https://aimedalliance.org/insurers-offering-new-types-of-low-cost-health-coverage-but-do-they-adequately-protect-consumers/) - Blue Cross Blue Shield of North Carolina is now offering a “My Choice” plan. Instead of a network of providers, the plan offers flat reimbursements for health care services. The plan uses a “reference pricing” model and reimburses providers at 40% more than what Medicare would pay for the same services. While this plan could
- [High Rate of Care Denials in California Overturned by the CA Department of Managed Health Care](https://aimedalliance.org/high-rate-of-care-denials-in-california-overturned-by-the-ca-department-of-managed-health-care/) - On March 14th, the California Chronic Care Coalition released a new report titled “Standing Up For Your Rights Creates Results.” This report brings attention to the staggering rate at which insurers in California are denying access to care for patients. Fortunately, the California Department of Managed Health Care (DMHC) has overturned 60 percent of these
- [Department of Justice Asks Court of Appeals to Invalidate the Affordable Care Act](https://aimedalliance.org/department-of-justice-asks-court-of-appeals-to-invalidate-the-affordable-care-act/) - In December 2018, District Court Judge Reed O’Connor ruled that the Patient Protection and Affordable Care Act (ACA) was unconstitutional after Congress nullified the individual mandate’s tax penalty for not maintaining health insurance coverage throughout the year. On March 25, 2019, the U.S. Department of Justice asked the 5th Circuit Court of Appeals to affirm
- [Aimed Alliance Weighs in on Texas Nonmedical Switching Bill](https://aimedalliance.org/aimed-alliance-weighs-in-on-texas-nonmedical-switching-bill/) - On March 28, 2019, Aimed Alliance sent a letter of support for Texas HB 2099, which would restrict insurers’ ability to modify their prescription drug formularies in the middle of the plan year. Specifically, this legislation would only allow insurers to modify their formularies during the open enrollment period and requires insurers to provide 60-days’
- [Patient Power and 15-40 Connection Discuss Cancer Detection Strategies for Patients](https://aimedalliance.org/patient-power-and-15-40-connection-discuss-cancer-detection-strategies-for-patients/) - The co-founder of Patient Power, Andrew Schorr, and the executive director of 15-40 Connection, Tricia Laursen, discuss key steps for early cancer detection. Early detection and diagnosis of cancer is important because it is more difficult to treat as the it becomes more advanced. This educational program was produced by Aimed Alliance and Patient Power.
- [Aimed Alliance Responds to the Administration’s Proposed Changes to the Anti-Kickback Statute](https://aimedalliance.org/aimed-alliance-responds-to-the-administrations-proposed-changes-to-the-anti-kickback-statute/) - On January 31st, the Department of Health and Human Services Office of the Inspector General (HHS-OIG) issued a proposed rule that would modify certain provisions of the federal Anti-Kickback Statute that protect rebating arrangements that are used in the pharmaceutical supply chain. Changing these rules has the potential to bring price relief to consumers who
- [Aimed Alliance Migraine Brochure Mentioned in AJMC](https://aimedalliance.org/aimed-alliance-migraine-brochure-mentioned-in-ajmc/) - An article published in the AJMC Newsroom on April 13 discussed challenges that people with migraine disease can face in the workplace. It highlighted Aimed Alliance’s “Women with Migraine Disease: Addressing Discrimination in the Workplace” brochure as a resource for patients. Continue reading the article here.
- [“Free” Preventive Care Isn’t Always Free](https://aimedalliance.org/free-preventive-care-isnt-always-free/) - Many people have reported that they experience billing complications when they receive preventive services that should be free, as required by the Patient Protection and Affordable Care Act. Consumer Reports has published an article exploring this issue to help consumers understand why this is happening and what they can do about it. This article features
- [The Art of Sabotage: CMS Seeks to End “Silver-Loading”](https://aimedalliance.org/the-art-of-sabotage/) - CMS has proposed to end the practice of “silver loading,” which could result in higher premiums and out-of-pocket costs for consumers. The “silver loading” strategy originated from the Trump Administration’s decision in 2017 to halt cost-sharing subsidy payments to insurers that are used to offset the cost of coverage. Halting these payments would have caused
- [CMS Embraces Nonmedical Switching and Copay Accumulator Policies](https://aimedalliance.org/cms-embraces-nonmedical-switching-and-copay-accumulator-policies/) - In the 2020 Notice of Benefit and Payment Parameters, CMS has proposed to allow marketplace plans to implement copay accumulator programs. This change would prevent the value of copay coupons and patient assistance from counting towards the plan’s deductible, which will keep patients in the deductible phase of their coverage longer and likely resulting in
- [Abandoning Treatment as Prevention?](https://aimedalliance.org/abandoning-treatment-as-prevention/) - Dr. David Hardy, the Chair of the HIV Medicine Association, has published an op-ed in Stat News analyzing the impact that a recent proposed rule could have on HIV prevention and treatment. CMS has proposed to weaken Medicare’s Six Protected Class protections, which will allow Medicare Part D plan sponsors to restrict access to Protected
- [Provider Perceptions Report Featured on StudyFinds](https://aimedalliance.org/provider-perceptions-report-featured-on-studyfinds/) - In Oct. 2018, we published the outcomes of a survey of health care practitioners designed to gauge their perceptions of utilization management techniques such as step therapy and prior authorization. A vast majority of providers have a negative perception of these practices, with 85 percent of providers being frustrated by them and taking out their
- [Pharmaceutical Middlemen Quietly Reap Profits on Generic Markups](https://aimedalliance.org/pharmaceutical-middlemen-quietly-reap-profits-on-generic-markups/) - The state of New York contracts with private insurers to cover the state’s low-income population, and these insurers often contract with Pharmacy Benefit Managers (PBMs) to handle prescription drug coverage. PBMs commonly put markups on medications to profit as an actor in the pharmaceutical supply chain. These markups vary from state to state, with some
- [Provider Perceptions Report Featured on Newsmax and Daily Mail UK](https://aimedalliance.org/provider-perceptions-report-featured-on-newsmax-and-daily-mail-uk/) - In Oct. 2018, we published the outcomes of a survey of health care practitioners designed to gauge their perceptions of utilization management techniques such as step therapy and prior authorization. This survey found that nearly 50 percent of providers are considering leaving medicine altogether because of how burdensome and time consuming these practices are. Our
- [Rebates Reconfigured: HHS Proposes to Reform the Rebate System](https://aimedalliance.org/rebates-reconfigured-hhs-proposes-to-reform-the-rebate-system/) - On Thursday, January 31st, the Department of Health and Human Services (HHS) and the HHS Office of the Inspector General (HHS-OIG) proposed a rule that would eliminate supply-side rebates paid to Pharmacy Benefit Managers (PBMs), Medicare Part D Plans, and Medicaid Managed Care Plans. HHS aims to achieve this by changing safe harbor protections under
- [Under Pressure: Rate of Underinsured Workers on the Rise](https://aimedalliance.org/under-pressure-rate-of-underinsured-workers-on-the-rise/) - Although enrollment among employer-sponsored health plans had historically been declining, new data from the Kaiser Family Foundation now indicates an increase in such enrollment. This trend should be good for consumers, as higher enrollment in employer-sponsored plans could represent a correlation with more people joining the workforce and having access to more robust insurance plans.
- [Provider Perceptions Report Featured on Beliefnet](https://aimedalliance.org/provider-perceptions-report-featured-on-beliefnet/) - In Oct. 2018, we published the outcomes of a survey of health care practitioners designed to gauge their perceptions of utilization management techniques such as step therapy and prior authorization. This survey found that nearly 50 percent of providers are considering leaving medicine altogether because of how burdensome and time consuming these practices are. Our
- [Aimed Alliance Collaborates with Patient Power to Educate Patients on Copay Accumulator Programs](https://aimedalliance.org/aimed-alliance-collaborates-with-patient-power-to-educate-patients-on-copay-accumulator-programs/) - Aimed Alliance Counsel Stacey L. Worthy joined Andrew Schorr from Patient Power on an episode of “Dear Stacey,” discussing copay accumulator programs and how they can impact patients. Andrew and Stacey focused on the rising popularity of copay accumulator programs and recent steps that the federal government has taken to allow more health plans to
- [Diabetes Advocate Pushes Back Against Copay Accumulator Programs](https://aimedalliance.org/diabetes-advocate-pushes-back-against-copay-accumulator-programs/) - Christel Marchand Aprigliano, the CEO of the Diabetes Patient Advocacy Coalition, authored an op-ed that was published today by Crains Cleveland Business. In this op-ed, Ms. Aprigliano discusses the dangers that copay accumulators present for diabetes patients who have historically relied on patient assistance from pharmaceutical manufacturers to afford their insulin. Ms. Aprigliano references the
- [Alliance for Patient Access Publishes New Study on Nonmedical Switching](https://aimedalliance.org/alliance-for-patient-access-publishes-new-study-on-nonmedical-switching/) - The Alliance for Patient Access (AfPA) published a new study today that analyzes how nonmedical switching practices impact patient outcomes. This study revealed that 60 percent of patients faced difficulty finding a medication that worked for them, and after being switched off of that medication, nearly 40 percent of patients found the new medication to
- [Dr. Marion Mass Publishes Two Opinion Pieces on HHS’s Rebate Proposal](https://aimedalliance.org/dr-marion-mass-publishes-two-opinion-pieces-on-hhss-rebate-proposal/) - Following the recent HHS proposal to curtail the use of rebates in the pharmaceutical supply chain, Dr. Marion Mass, a Philadelphia-based pediatrician, has authored two opinion pieces explaining how pharmaceutical rebates are used by middlemen in the supply chain and how they inflate the cost of medications. One op-ed was published by The Washington Post,
- [Aimed Alliance Director of Medical Affairs Calls on Policymakers to Improve Physician Autonomy](https://aimedalliance.org/aimed-alliance-director-of-medical-affairs-calls-on-policymakers-to-improve-physician-autonomy/) - Drawing on the findings of a physician survey released by Aimed Alliance in October, the organization’s Director of Medical Affairs, Dr. Shannon Ginnan, calls on legislators to find ways to restore autonomy for health care providers who are increasingly losing control over medical decision making due to cost-saving strategies used by health insurers. Dr. Ginnan
- [Heartland Institute Podcast Highlights Hidden Risks of Copay Accumulators](https://aimedalliance.org/heartland-institute-podcast-highlights-hidden-risks-of-copay-accumulators/) - The Heartland Institute’s Sarah Lee speaks with Aimed Alliance counsel Stacey L. Worthy about the rise of copay accumulator programs, and how these supposed cost-saving measures can backfire on employers. Copay accumulators harm patients who depend on copay assistance for medication, and allow insurers to “double dip” on deductible costs. Listen to the podcast. Get
- [California Chronic Care Coalition Highlights Aimed Alliance Report Detailing Physician Frustration With Insurers in Its Guide to Choosing a Health Plan](https://aimedalliance.org/california-chronic-care-coalition-highlights-aimed-alliance-report-detailing-physician-frustration-with-insurers-in-its-guide-to-choosing-a-health-plan/) - The California Chronic Care Coalition published guidance on how to choose a health insurance plan that best fits consumers’ needs. The news release describing the guide, published as part of the group’s “My Patients Rights” campaign, draws on key data from Aimed Alliance’s “Putting Profits Before Patients” survey of over 600 physicians. The Aimed Alliance
- [Aimed Alliance Counsel Explains How Appeals Can Pay Off for Denied ER Visits](https://aimedalliance.org/appealing-denials-can-pay-off-for-denied-er-visits/) - Did you know that you have a right to health insurance coverage for an emergency room visit if you believed you needed emergency care? Health insurers deny emergency room claims to make enrollees wary of being hit with big hospital bills. Aimed Alliance counsel Stacey L. Worthy explains how to reverse a denial through the
- [Aimed Alliance Counsel Explains Copay Accumulator Plans Put Employers in Legal Jeopardy](https://aimedalliance.org/aimed-alliance-counsel-explains-copay-accumulator-plans-put-employers-in-legal-jeopardy/) - America spends more on health care than any other country in the world, and health care premiums continue to rise. Large employers are trying to combat this issue by instituting health plans that shift more of the burden of cost onto their employees, including through the use of copay accumulator programs. These programs not only
- [Ohio Legislature Passes Bill to Protect Patients from Step Therapy](https://aimedalliance.org/ohio-legislature-passes-bill-to-protect-patients-from-step-therapy/) - The Ohio legislature passed SB 265, which strengthens protections for patients who are subject to step therapy by their insurer. Step therapy occurs after a doctor prescribes medication an insurance company may consider too new or expensive, forcing the patient to try other drugs that may not work before the company will pay for their
- [Pharmaceutical Commerce Highlights Aimed Alliance’s Copay Accumulator Report](https://aimedalliance.org/pharmaceutical-commerce-highlights-aimed-alliances-copay-accumulator-report/) - ..
- [Idaho Governor Intends to Offer Illegal Insurance Plans](https://aimedalliance.org/idaho-governor-intends-to-offer-illegal-insurance-plans/) - The newly-elected Governor of Idaho Brad Little (R) announced in his State of the State address on Monday evening that he will continue the previous governor’s efforts to create state-level health insurance plans that do not comply with the requirements of the Patient Protection and Affordable Care Act (ACA). Governor Butch Otter (R) originally issued
- [University of Maryland Medical Center Surgeon Pioneers Transplant Delivery](https://aimedalliance.org/university-of-maryland-medical-center-surgeon-pioneers-transplant-delivery/) - Transporting an organ from a donor to a recipient is often a cumbersome process that is prone to mishaps. Dr. Joseph Scalea, a surgeon from the University of Maryland Medical Center, has been testing the use of drones as a faster, more convenient option for organ transportation and delivery. So far, Dr. Scalea has successfully
- [Netflix and Pill: Louisiana Gov. to Test New Rx Payment Model](https://aimedalliance.org/netflix-and-pill/) - ..
- [Covered by the Crowd: Medical Fundraisers One-Third of GoFundMe Campaigns](https://aimedalliance.org/covered-by-the-crowd/) - According to the CEO of GoFundMe, Rob Solomon, medical fundraisers now account for one-third of fundraising campaigns hosted by the crowdfunding website. This tactic is increasingly used by patients to defray the cost of expensive medical bills. Sara Collins, an economist at the Commonwealth Fund, claims that these exorbitant costs are partially due to high
- [<a href="https://aimedalliance.org/wp-content/uploads/2018/10/Aimed-Alliance-Step-Therapy-in-Medicare-Advantage-Plans-Fact-Sheet.pdf" target="_blank" rel="noopener noreferrer">Aimed Alliance Step Therapy in Medicare Advantage Plans Fact Sheet</a>](https://aimedalliance.org/aimed-alliance-step-therapy-in-medicare-advantage-plans-fact-sheet/) - Aimed Alliance Step Therapy in Medicare Advantage Plans Fact Sheet
- [<a href="https://aimedalliance.org/wp-content/uploads/2018/10/MigrainePatientsEdit.pdf" target="_blank" rel="noopener noreferrer">Know Your Rights Migraine Patients</a>](https://aimedalliance.org/know-your-rights-migraine-patients/) - Migraine Patients Know Your Rights brochure (PDF 1 MB)
- [<a href="https://aimedalliance.org/wp-content/uploads/2018/10/Know-Your-Rights-Brochure-for-Individuals-with-Cancer.pdf" target="_blank" rel="noopener noreferrer">Know Your Rights for People with Cancer</a>](https://aimedalliance.org/know-your-rights-for-people-with-cancer/) - Know Your Rights brochure – A resource for people with cancer and their loved ones. (PDF 830 KB)
- [<a href="https://aimedalliance.org/wp-content/uploads/2016/12/Know-Your-Rights-web-brochure-1.pdf" target="_blank" rel="noopener noreferrer">Aimed Alliance Creates “Know Your Rights” Brochure to Educate Patients on Appealing Coverage Denials</a>](https://aimedalliance.org/aimed-alliance-creates-know-your-rights-brochure-to-educate-patients-on-appealing-coverage-denials/) - Know Your Rights brochure to Educate Patients on Appealing Coverage Denials (PDF).
- [BenefitsPro Highlights Aimed Alliance’s Copay Accumulators Report to Explain Legal Risks to HR Professionals](https://aimedalliance.org/benefitspro-highlights-aimed-alliances-copay-accumulators-report-to-explain-legal-risks-to-hr-professionals/) - Aimed Alliance counsel Stacey L. Worthy explains in a recent news article why copay accumulators are an unfair and discriminatory tool used by insurers that punishes patients who struggle to afford their medication. The article highlights recent Aimed Alliance analysis of how copay accumulator programs may actually cost employers more money in the long run,
- [<a href="https://aimedalliance.org/wp-content/uploads/2018/07/Aimed-Alliance-Comment-on-Blueprint-to-Lower-Drug-Prices.pdf" target="_blank" rel="noopener noreferrer">Aimed Alliance Responds to HHS’s Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs</a>](https://aimedalliance.org/aimed-alliance-responds-to-hhss-blueprint-to-lower-drug-prices-and-reduce-out-of-pocket-costs/) - ...
- [<a href="https://aimedalliance.org/wp-content/uploads/2018/07/Aimed-Alliance-Statement-on-Biosimilars.pdf" target="_blank" rel="noopener noreferrer">Aimed Alliance Releases Its Position Statement on Biosimilars</a>](https://aimedalliance.org/aimed-alliance-releases-its-position-statement-on-biosimilars/) - ...
- [<a href="https://aimedalliance.org/wp-content/uploads/2018/08/Diabetes-Access-Guide-HCP.pdf" target="_blank" rel="noopener noreferrer">Diabetes Access Guide for Health Care Providers</a>](https://aimedalliance.org/diabetes-access-guide-for-health-care-providers/) - Exceptions and Appeals - How to help your patients access their diabetes treatment. Read here.
- [<a href="https://aimedalliance.org/wp-content/uploads/2018/08/Diabetes-Access-Guide-Patients.pdf" target="_blank" rel="noopener noreferrer">Diabetes Access Guide for Patients</a>](https://aimedalliance.org/diabetes-access-guide-for-patients/) - Take Control, Request Access. Your guide to requesting access to your diabetes therapy. Read more.
- [Survey: Insurer Interference with Physicians’ Professional Judgement Compromises Patient Health](https://aimedalliance.org/survey-insurer-interference-with-physicians-professional-judgement-compromises-patient-health/) - Many Doctors Looking to Leave the Profession. Nine in ten primary care physicians (92 percent) say staff employed by insurance companies are not competent to make medical decisions about treatment regimens, according to a new physician survey released today by the nonpartisan, nonprofit Alliance for the Adoption of Innovations in Medicine (Aimed Alliance).
- [Fierce Healthcare Reports on Aimed Alliance’s Findings: “Doctors Worry About Insurers Overriding their Treatment Decisions"](https://aimedalliance.org/fierce-healthcare-reports-on-aimed-alliances-findings-doctors-worry-about-insurers-overriding-their-treatment-decisions/) - Doctors treatment decisions for their patients are being overridden by insurers with increasing frequency, a recent study by Aimed Alliance shows. Of the 600 doctors surveyed, 89% say they no longer have an acceptable amount of influence in healthcare decisions for their patients, and 87% say that health insurers interfere with their ability to prescribe
- [Provider Perceptions Report Supports Research Showing that Health Plans Lack Proper Coverage for People with Autoimmune Diseases](https://aimedalliance.org/provider-perceptions-report-supports-research-showing-that-health-plans-lack-proper-coverage-for-people-with-autoimmune-diseases/) - Let MI Doctors Decide conducted a study on Michigan’s top 25 health insurance plans, and none of them received a grade higher than “C.” Grading assessed the ability of plan beneficiaries with Crohn’s disease, multiple sclerosis, psoriasis, psoriatic arthritis, and rheumatoid arthritis to access their medications. The study notes that patients in Michigan face substantial
- [Ohio Hospitals Risk Patient Health With Nonmedical Switching Policies](https://aimedalliance.org/ohio-hospitals-risk-patient-health-with-nonmedical-switching-policies/) - Aimed Alliance counsel Stacey L. Worthy explains how Ohio hospitals seeking cost savings by forcing stable patients to switch medications are putting patients at risk for health complications. Moreover, these policies create a conflict of interest for health care practitioners who are torn between providing appropriate care to their patients and abiding by their employers’
- [Health Insurance Matters Glossary of Terms](https://aimedalliance.org/health-insurance-matters-glossary-of-terms/) - A glossary of commonly used terms related to health plans, coverage, and access to care. Download here.
- [Drug Formulary Exclusion Lists Reduce Patient Access to Treatment](https://aimedalliance.org/drug-formulary-exclusion-lists-reduce-patient-access-to-treatment/) - Drug formulary exclusion lists have grown by 160 percent since 2014, hindering patient access to treatment. By Sara Heath January 04, 2018 - Drug formulary exclusion lists are getting longer, making it more difficult for patients to access the medications and treatments they may need to manage their illnesses, according to a recent study from
- [Proposed Bipartisan Cancer Drug Parity Act Extends Treatment Protections for Privately Insured Cancer Patients](https://aimedalliance.org/proposed-bipartisan-cancer-drug-parity-act-extends-treatment-protections-privately-insured-cancer-patients/) - Legislation introduced by U.S. Congressmen Leonard Lance (R–N.J.) and Brian Higgins (D–N.Y.) would ensure that the estimated 60 percent of Americans whose private health benefits are regulated by federal law will receive cost-sharing parity for orally administered cancer treatments. Although 43 states have already passed oral parity laws, there are still privately insured patients who
- [Study Shows Insurers Requiring Overly Burdensome Prior Authorization for New Class of Cholesterol Medications](https://aimedalliance.org/study-shows-insurers-requiring-overly-burdensome-prior-authorization-new-class-cholesterol-medications/) - According to a new study analyzing 2017 findings reported in JAMA Cardiology, fewer than one in three adults who were prescribed PCSK9 inhibitors--a new class of medications to treat patients with genetic conditions associated with high cholesterol--actually receive them. The new study from the Perelman School of Medicine at the University of Pennsylvania found that
- [Will A Trio of U.S. Companies Transform the Delivery of Health Care?](https://aimedalliance.org/will-trio-u-s-companies-transform-delivery-health-care/) - Three leading U.S. companies have committed to tackling one of the biggest problems facing American companies and their employees—the rising cost of health care. The trio vows to form an independent entity free of "profit-making incentives" that will aim to improve employee satisfaction and reduce health care costs. Read more here.
- [California Insurance Commissioner Investigates Aetna After Troubling Admissions from Former Medical Director](https://aimedalliance.org/california-insurance-commissioner-investigates-aetna-troubling-admissions-former-medical-director/) - Aetna's former Medical Director admits under oath that he did not review patients’ records before deciding whether to deny or approve care. California's Insurance Commissioner has launched an investigation to determine the pervasiveness of the practice. The Commissioner suggested that the former Medical Director’s actions may have violated the law, and he encourages patients who
- [Legislation Lifting "Gag Clauses" in Several States Empowers Pharmacists to Inform Consumers of Cost Savings](https://aimedalliance.org/legislation-lifting-gag-clauses-several-states-empowers-pharmacists-inform-consumers-cost-savings/) - State officials in at least five states have enacted laws to end "gag clauses" imposed on pharmacists by pharmacy benefit managers. The gag clauses restrict pharmacists from informing customers that they may save money if they pay cash for their prescriptions instead of processing the payments through insurance. At least 12 other states are considering
- [One of Nation’s Largest Health Insurers to Pass Pharmacy Discounts on to Plan Participants](https://aimedalliance.org/one-of-nations-largest-health-insurers-to-pass-pharmacy-discounts-on-to-plan-participants/) - In response to growing public concern over rising drug prices, one of the country’s largest health insurers announced that it will now share with plan participants the discounts it receives from drug companies.
- [New York Patients Are Being Forced Off Prescribed Medications During the Plan Year, Providing A Need for New Legislation to Fix the Problem](https://aimedalliance.org/new-york-patients-are-being-forced-off-prescribed-medications-during-the-plan-year-providing-a-need-for-new-legislation-to-fix-the-problem/) - Global Healthy Living Foundation survey finds nearly all respondents (98.2%) support legislation prohibiting insurance companies from financially pressuring them to switch from their prescribed medication UPPER NYACK, N.Y.--(BUSINESS WIRE)--On behalf of a group of 36 patient and provider groups, today Global Healthy Living Foundation (GHLF) released results of a survey showing that a majority of
- [Know Your Rights Featured in National Black Nurses Association Newsletter](https://aimedalliance.org/know-your-rights-featured-in-national-black-nurses-association-newsletter/) - Know Your Rights Featured in National Black Nurses Association Newsletter
- [Dear Stacey: Your Coverage Questions Answered](https://aimedalliance.org/dear-stacey-your-coverage-questions-answered/) - We’ve rounded up some of your Dear Stacey questions to find out what cancer patients can expect from their insurance plan, how to navigate and understand coverage, rights as an employee and more. Stacey Worthy, Counsel to Aimed Alliance of healthcare law and policy, provides guidance on coverage and potential restrictions, and shares useful information
- [Agenda Preserving The Right To Quality Care:  Spotlight On Migraine Disorders](https://aimedalliance.org/agenda-preserving-the-right-to-quality-care-spotlight-on-migraine-disorders/) - An Advocacy Workshop on Protecting Coverage and Access to Individualized Treatments and Preferred Providers View Event Details | View Speaker Bios AGENDA June 26, 2018 San Francisco, CA 6:30 PM Registration and Dinner 6:45 PM Welcome, Objectives, and Introductions Stacey Worthy, JD, Counsel, Aimed Alliance 6:55 PM Federal Update: The Politics of Coverage Shruti Kulkarni,
- [Speaker Biographies](https://aimedalliance.org/speaker-biographies/) - Preserving The Right To Quality Care: Spotlight On Migraine Disorders June 26, 2018 | San Francisco, CA View Event Details | View Workshop Agenda Stacey Worthy, JD Counsel Aimed Alliance As Counsel to Aimed Alliance, Stacey Worthy provides legal insights that drive the organization’s education, advocacy, and policy initiatives. Based on her extensive research and
- [New Texas Law Seeks To Protect Patients from Surprise Medical Bills After Receiving Care in ERs](https://aimedalliance.org/new-texas-law-seeks-protect-patients-surprise-medical-bills-receiving-care-ers/) - A new Texas law requires freestanding emergency rooms (ERs) to post a list of the insurance plans that consider them “in-network.” The law seeks to protect consumers from surprise medical bills after they receive care. Read more here.
- [Alliance Urges Trial Attorneys to Help Patients when Health Insurers Violate Consumer Protection Laws](https://aimedalliance.org/alliance-urges-trial-attorneys-help-patients-health-insurers-violate-consumer-protection-laws/) - As The New York Times reports that health insurers contribute to the nation’s drug overdose epidemic by denying coverage of less-risky opioids and addiction treatments, a national alliance is encouraging trial attorneys to help consumers challenge illegal health insurance practices.
- [Former U.S. Sen. Elizabeth Dole To Chair VA Caregiver Advisory Committee](https://aimedalliance.org/former-u-s-sen-elizabeth-dole-chair-va-caregiver-advisory-committee/) - Former North Carolina Senator Elizabeth Dole will chair a new family and caregiver advisory committee formed by the U.S. Department of Veterans Affairs in response to problems identified with the agency’s caregiver programs. The new committee of veterans and military caregivers will advocate for ways to improve VA care and benefits services for families of
- [FDA Commissioner Convenes Task Force to Prevent Drug Shortages Following Hurricane Maria](https://aimedalliance.org/fda-commissioner-convenes-tasks-force-prevent-drug-shortages-following-hurricane-maria/) - Earlier this week, Food and Drug Administration (FDA) Commissioner Scott Gottlieb established a task force to mitigate anticipated drug shortages resulting from hurricane Maria’s impact on manufacturing facilities in Puerto Rico. The task force will work closely with federal and local governments to prevent the loss of life-sustaining and life-saving medications that are manufactured on
- [Study Shows Military Treatment Centers Offer Integrative Care](https://aimedalliance.org/study-shows-military-treatment-centers-offer-integrative-care/) - A new study shows that military treatment facilities are offering integrative health services, such as complementary and alternative medicine (CAM), to treat pain and mental health conditions holistically. The availability of CAM service is increasing over time, and the military health system is incorporating the use of integrated health services into its clinical practice guidelines.
- [Despite New Consumer Protection Laws, Individuals with Cancer Still Cannot Afford Their Treatments](https://aimedalliance.org/despite-new-consumer-protection-laws-individuals-cancer-still-cannot-afford-treatments/) - Despite the enactment of oral parity laws, individuals with cancer are still having difficulty affording their medications. A new study suggests that high insurance deductibles and high coinsurance are the culprits. Read more here.
- [Vets Have to Wait Years for Response to Health Claim Appeals](https://aimedalliance.org/vets-wait-years-response-health-claim-appeals/) - Veterans who are denied health benefits have to wait years for their appeals to go through due to an outdated appeals process. Read more here.
- [California Insurer to Pay $5 Million for Failure To Address Appeals](https://aimedalliance.org/california-insurer-pay-5-million-failure-address-appeals/) - California’s Department of Managed Health Care fined Anthem Blue Cross $5 million for failing to address consumer's complaints and requests for appeals in a timely manner. In failing to do so, the Department found that Anthem violated state laws. Read more here. To learn how to file an appeal, visit us at CoverageRigths.org.
- [Surprise Hospital Bill Laws May Not Apply To All Health Plans](https://aimedalliance.org/surprise-hospital-bill-laws-may-not-apply-health-plans/) - Twenty-one states have enacted laws to prevent hospitals from sending surprise medical bills for unexpected out-of-network charges. Yet, if you have a self-funded plan, these laws may not apply to you. Speak with your employer to ensure proper coverage. Read more here.
- [Insurer Denies Young Epilepsy Patient’s Brain Surgery](https://aimedalliance.org/insurer-denies-young-epilepsy-patients-brain-surgery/) - Aetna denied a minimally invasive brain surgery procedure to a 15-year-old epilepsy patient, claiming it was too "experimental." Practitioners disagree and state that is it safer than alternative procedures. This is a prime example of why we need prior authorization reform laws to prevent interference with the practitioner-patient relationship. Read more here.
- [Telemedicine Has the Potential To Meet Veterans’ Unmet Needs](https://aimedalliance.org/telemedicine-potential-meet-veterans-unmet-needs/) - The U.S. Department of Veterans Affairs (VA) plans to issue regulations to pave the way for VA providers to use telemedicine to treat veterans regardless of their geographic location. Opponents cite concerns that the new regulations could interfere with the states’ power to regulate the practice of medicine. Proponents of the new regulation, however, view
- [Aimed Alliance Counsel Discusses Impact of Formulary Exclusion Lists on Patients](https://aimedalliance.org/aimed-alliance-counsel-discusses-impact-formulary-exclusion-lists-patients/) - Counsel to Aimed Alliance, Stacey Worthy, discussed the impact on formulary exclusion lists on patients in a recent article for Cleveland.com. In the article, Ms. Worthy notes that many people are unaware of formulary exclusion lists. They are often under the impression that their medication will be covered simply because they have insurance and are
- [States May Bolster the Affordable Care Act by Enacting Individual Mandates](https://aimedalliance.org/states-may-bolster-affordable-care-act-enacting-individual-mandates/) - Recent legislative actions on Capitol Hill to repeal elements of the Affordable Care Act (ACA) may not have the desired effect in some states. Efforts to destabilize the individual insurance markets will only work when individual states do not act to strengthen their own insurance markets. Learn how states can preserve key elements of the
- [Aimed Alliance Featured in Latest Issue of American Health & Drug Benefits](https://aimedalliance.org/aimed-alliance-featured-latest-issue-american-health-drug-benefits/) - The latest issue of American Health & Drug Benefits features an article entitled, “Emphasize Shared Decision-Making Between Physicians and Patients to Improve Diabetes Outcomes,” coauthored by Executive Director, Stacey Worthy. The article discusses how pharmacy benefit managers can take a patient-centered approach to advance diabetes treatment and care with the use of these medicines. Read
- [Aimed Alliance Op-Ed in The Washington Examiner Describes the Negative Impact of Non-Medical Switching on U.S. Businesses](https://aimedalliance.org/aimed-alliance-op-ed-washington-examiner-describes-negative-impact-non-medical-switching-u-s-businesses/) - The Washington Examiner published an op-ed by Aimed Alliance’s Executive Director, Stacey L. Worthy. Ms. Worthy describes how interrupting an employees’ treatment by switching their medication or changing a health plan’s formulary to reduce coverage for a drug can result in loss of productivity and increased costs for employers. Read the full op-ed here.
- [Insurers Step in To Provide Coverage to 19 Counties in OH](https://aimedalliance.org/insurers-step-provide-coverage-19-counties-oh/) - Five health insurers are stepping up to provide insurance in 19 counties in Ohio that would otherwise not have insurers on the ACA exchanges in 2018. Twenty Ohio counties were at risk of having no insurers after Anthem announced it was dropping out of the Ohio market next year. Read more here.
- [Senate Passes Bill To Improve Treatments for Childhood Cancers](https://aimedalliance.org/senate-passes-bill-improve-treatments-childhood-cancers/) - Yesterday, the Senate passed a bill requiring the pharmaceutical industry to study the safety and efficacy of adult cancer treatments on children. Advocates of the bill claim it is a step forward in providing more breakthrough treatments for children battling cancer. Read more here.
- [Celgene Commits To Improving Access to Precision Medicines](https://aimedalliance.org/celgene-commits-improving-access-precision-medicines/) - Precision medicine is crucial to providing highly effective, high-value care to patients with serious diseases. Celgene CEO, Mark Alles, states he is committed to working with health care payers to improve access to precision medicines to patients who need them. Read more here.
- [Transparent Databases Can Protect Patients from Surprise Medical Billing](https://aimedalliance.org/transparent-databases-can-protect-patients-surprise-medical-billing/) - Creating a transparent database of emergency care costs and reimbursement rates can protect patients from surprise medical billing after an emergency room visit. A database can ensure that emergency room doctors are reimbursed at a fair rate and patients are not financially harmed. Read more here.
- [According to New Lawsuit, CVS Health Allegedly Overcharged for Generic Drugs](https://aimedalliance.org/according-new-lawsuit-cvs-health-allegedly-overcharged-generic-drugs/) - On Monday, a class-action lawsuit was filed against CVS Health, alleging that the company colluded with third-party pharmacy benefit managers (PBMs). The plaintiffs argued that pharmacy and PBMs increased the prices of generic prescription drugs by charging co-pays that exceed the pharmacists’ price and profit. The complaint also alleged that customers using insurance were charged
- [Bringing Down the Cost of Care Through Competition](https://aimedalliance.org/bringing-cost-care-competition/) - In a new op-ed, Dr. Tom Coburn points out that while the average out-of-pocket costs for patient are falling, an increasing number of patients with high deductible plans or plans with multiple tiers for medications are seeing higher out-of-pocket costs. The solution is not to institute price controls. Instead, Dr. Coburn recommends incentivizing the development
- [Aimed Alliance Op-Ed on Doctor-Patient Rights Project Survey Featured in Newsweek](https://aimedalliance.org/aimed-alliance-op-ed-doctor-patient-rights-project-survey-featured-newsweek/) - Newsweek published an op-ed by Aimed Alliance’s Executive Director, Stacey L. Worthy in which she discusses how insurance companies interfere with treatment decisions. Ms. Worthy highlighted a survey by the Doctor-Patient Right Project, which found that many Americans agree that doctors, and not insurers, should play a primary role in driving treatment decisions for their
- [FDA's REMS Program Protects Women's Health](https://aimedalliance.org/fdas-rems-program-protects-womens-health/) - The FDA's Risk Evaluation and Mitigation Strategies (REMS) program ensures valuable medicines that would not otherwise be on the market are available for patients who need them, including women. REMS allows access to treatments for conditions that impact women at higher rates, including mental health disorders, irritable bowel syndrome, and sexual dysfunction. Read more here.
- [High Rates of Insurer Coverage Denials Could Spark Bipartisan Health Care Reform](https://aimedalliance.org/high-rates-insurer-coverage-denials-spark-bipartisan-health-care-reform/) - A recent survey by the Doctor-Patient Rights Project found that nearly 53 million insured Americans are denied coverage for treatments for chronic conditions. As the debate over health care reform continues, the survey findings may encourage lawmakers to ensure consumers receive the health coverage they pay for. Read more here.
- [Aimed Alliance Quoted in CBS News on Doctor-Patient Rights Project Survey](https://aimedalliance.org/aimed-alliance-quoted-cbs-news-doctor-patient-rights-project-survey/) - Aimed Alliance’s Executive Director, Stacey L. Worthy, was quoted in CBS News on a recent survey by the Doctor-Patient Rights Project which highlighted the high rate of health insurer denials for necessary treatments. Ms. Worthy discusses how patients with chronic illnesses feel their insurance is worthless when insurers deny essential treatments that are prescribed by
- [Patients with Pre-Existing Conditions Harmed When Insurers Deny Treatment](https://aimedalliance.org/patients-pre-existing-conditions-harmed-insurers-deny-treatment/) - According to a new op-ed in the Wall Street Journal, many health plans deny coverage for medical treatments and impose utilization management rules that restrict access to drugs, creating significant obstacles to treatment for patients with pre-existing conditions. These practices increase overall health care costs and also worsen health outcomes for patients who suffer from
- [Small Employers Offer Competitive Health Insurance Benefits, According to New Study](https://aimedalliance.org/small-employers-offer-competitive-health-insurance-benefits-according-new-study/) - According to a new survey, small employers have similar health insurance benefits compared to the average large employer, and keep plan costs generally below average. Although these results are encouraging, the survey also found that small employers pass more of the costs onto employees compared to all employers. Read more here.
- [Ca. Introduces Bill To Help Patients Who Are Forced To Switch Health Plans](https://aimedalliance.org/ca-introduces-bill-help-patients-forced-switch-health-plans/) - Insurers that withdraw from the health exchange marketplaces can disrupt patient care because such patients may lose access to their health care providers under their new plan. Proposed continuity of care legislation in California allows patients with individual health insurance plans and chronic, acute, or terminal illnesses to keep their providers for up to a year, even
- [Aimed Alliance in Idaho Statesman: Step Therapy Interferes with Treatment](https://aimedalliance.org/aimed-alliance-idaho-statesman-step-therapy-interferes-treatment/) - Aimed Alliance’s Executive Director was quoted in the Idaho Statesman’s article detailing how the health insurance industry’s “fail first”, or step therapy, practices interfere with a provider’s ability to make individualized treatment decisions. Read more here.
- [Successfully Cutting Pharmacy Benefit Managers (PBMS) out of the Equation Yielded Lower Total Drug Costs for One Fortune 500 Company](https://aimedalliance.org/successfully-cutting-pharmacy-benefit-managers-pbms-equation-yielded-lower-total-drug-costs-one-fortune-500-company/) - Employers are increasingly recognizing the need to develop more cost-effective ways to provide prescription drug benefits to employees. One Fortune 500 company reduced total drug costs by putting PBMs on the chopping block, and creating direct-to-pharmacy agreements. Identifying innovative approaches to delivering prescription drug benefits is a growing trend among major companies. PBM reform is
- [Senate Health Bill Lacks Vital Patient Protections](https://aimedalliance.org/senate-health-bill-lacks-vital-patient-protections/) - Aimed Alliance collaborator Michael Barnes took to cable news to discuss the pitfalls of the Graham-Cassidy health care bill before the U.S. Senate. The bill would repeal of the Affordable Health Care Act’s federal patient protections, including essential health benefits. This segment aired on September 21, 2017.
- [Two Studies Involving Personalized Cancer Vaccines Show Success](https://aimedalliance.org/two-studies-involving-personalized-cancer-vaccines-show-success/) - Two clinical trials in which researchers formulated personalized vaccines tailored to treat several patients with melanoma have shown promise in staving off tumors. After receiving the vaccines, most of the patients experienced a complete remission or saw their tumors shrink in size, proving hopeful for the future of cancer immunotherapy. Read more here.
- [CDC Report Highlights Cancer Incidence and Death Rates in Rural and Urban Areas](https://aimedalliance.org/cdc-report-highlights-cancer-incidence-death-rates-rural-urban-areas/) - A new report by the Centers for Disease Control and Prevention (CDC) shows that rural areas have lower incidence rates of cancer than urban areas, but higher death rates. The differences in death rates may reflect disparities in access to health care, and diagnosis and treatment in rural areas. Read the full report here.
- [Sen. Mitch McConnell Suggests Bipartisan Fix if ACA Repeal Fails](https://aimedalliance.org/sen-mitch-mcconnell-suggests-bipartisan-fix-aca-repeal-fails/) - On Thursday, Senate Majority Leader Mitch McConnell stated that a bipartisan fix will be needed if Republicans continue to struggle on a replacement to the Affordable Care Act. McConnell also stated nonaction is not option as insurance markets are collapsing across the country. Read more here.
- [Wearable UV Patch Helps Protect Against Health Effects from Prolonged Sun Exposure](https://aimedalliance.org/wearable-uv-patch-helps-protect-health-effects-prolonged-sun-exposure/) - A new wearable ultraviolet (UV) patch can monitor UV rays to help protect against potential health effects that can result from prolonged sun exposure. The patch’s photosensitive dyes change color and users can scan the patch for sun safety tips, such as knowing when to re-apply sunscreen. Read more here.
- [Celgene CEO Offers Proposals To Improve Patient Access to Affordable Drug Therapies](https://aimedalliance.org/celgene-ceo-offers-proposals-improve-patient-access-affordable-drug-therapies/) - In a recent article, Celgene CEO, Mark Alles, offered three proposals that would dramatically improve access and cost to innovative therapies for many Americans, particularly those with chronic diseases. Alles proposed removing regulatory barriers to value-based contracting, oral parity laws for oral anticancer medications, and patient protections for step therapy. Read more here.
- [Blue Cross Blue Shield Proposes Rate Increases in Ga. Amid Uncertainty in Washington](https://aimedalliance.org/blue-cross-blue-shield-proposes-rate-increases-ga-amid-uncertainty-washington/) - Amid uncertainty of the future of the Affordable Care Act, Blue Cross Blue Shield proposed rate increases in Georgia if the government plans to stop funding cost-sharing subsidies. For consumers covered under the state exchanges, average rates could increase an average of 40.6 percent in 2018, pricing many consumers out of the individual market. Read
- [Aetna Threatens To Exit Ill. Medicaid Managed Care Program](https://aimedalliance.org/aetna-threatens-exit-ill-medicaid-managed-care-program/) - Aetna recently filed a notice of intent to terminate its Medicaid managed care contracts with Illinois after the state did not pass a budget by July 1, stating that Illinois owed the insurer $698 million. Illinois passed a budget late Thursday afternoon, however, Aetna declined to comment on whether it has chosen to terminate its
- [Medicare Beneficiaries Receiving Observation Care Later Surprised by Hospital, Nursing Home Bills](https://aimedalliance.org/medicare-beneficiaries-receiving-observation-care-later-surprised-hospital-nursing-home-bills/) - Many Medicare beneficiaries are surprised by hospital and nursing home bills, finding out Medicare did not cover services while they were receiving observation status. Many beneficiaries also move into a nursing home after their hospital stay in observation status, prompting legislation that would count time in observation care toward the three-day inpatient rule for nursing
- [Pricing Transparency Could Help Lower Prescription Drug Costs](https://aimedalliance.org/pricing-transparency-help-lower-prescription-drug-costs/) - As consumers continue to pay more out-of-pocket costs for prescription drugs, greater price transparency is a crucial element to ensuring patients are getting the best value for their health care. There are several ways to ensure insurance rebates and discounts are passed down to consumers, including promoting transparency by pharmacy benefit managers and value-based payment
- [Community Oncology Alliance Explains PBMs’ Impact on Patients](https://aimedalliance.org/community-oncology-alliance-explains-pbms-impact-patients/) - In a new video from the Community Oncology Alliance, consumers can learn about the impact pharmacy benefit managers (PBMs) have on medication affordability. The video highlights how PBMs, operating as middlemen between insurance companies and pharmacies, have significantly contributed to the spike in prescription drug prices. Watch the video here.
- [The Future of Telemedicine Can Help Address Access to Care Issues](https://aimedalliance.org/future-telemedicine-can-help-address-access-care-issues/) - Telemedicine has been gaining more popularity as a way to increase patients’ access to care, particularly for individuals in rural areas and older Americans. Federal regulations can help address quality and reimbursement concerns in treating patients remotely. Read more here.
- [New Report Recommends Ways To Improve Access to Electronic Health Records](https://aimedalliance.org/new-report-recommends-ways-improve-access-electronic-health-records/) - A new report by the Office of the National Coordinator for Health Information Technology (ONC) offered recommendations to make it easier for patients to access their medical records. Recommendations include an online patient portal and e-verification system to simplify the process. Read more here.
- [Federal Proposal Allowing Importation of Foreign Drugs Could Harm Patients](https://aimedalliance.org/federal-proposal-allowing-importation-foreign-drugs-harm-patients/) - A recent federal proposal that would allow importation of foreign drugs could risk the health of patients seeking lower-cost prescriptions. Such drugs could be counterfeit or adulterated, and as a result, lack their active ingredient or contain harmful substances. Some pharmacists have offered other alternatives that would not risk patient safety, including speeding up the
- [Patient Power Says Sen. McCain’s Cancer Diagnosis Highlights Need for More Cancer Research](https://aimedalliance.org/patient-power-says-sen-mccains-cancer-diagnosis-highlights-need-cancer-research/) - Patient Power wishes Senator McCain well in light of his recent brain cancer diagnosis. The organization also highlights the need for more cancer research and better access to adequate cancer treatment. Read more here.
- [More Research Needed To Prevent Medical Errors](https://aimedalliance.org/research-needed-prevent-medical-errors/) - Medical errors are the third-leading cause of death in the United States. As such, more research is needed to prevent medical errors and ensure patient safety. Read more here.
- [Over Half of Individuals Globally with HIV Now Taking Medication](https://aimedalliance.org/half-individuals-globally-hiv-now-taking-medication/) - According to a recent United Nations report, more than half of individuals globally with HIV are now taking medication to treat the virus due to billions of dollars invested in disease prevention. This is step towards progress, although experts warn those numbers could change if funding levels decline. Read more here.
- [Personalized Medicine for Effective Treatments](https://aimedalliance.org/personalized-medicine-effective-treatments/) - The availability of digital technology has advanced the practice of precision medicine. Precision medicine can provide greater access to data can increase the ability to make more informed medical decisions, treatments with high probability of success, reduce side effects, and more attention on disease prevention. Read more here.
- [DC’s Prevention Campaign Significantly Decreased HIV Infection Rates Over the Past Decade](https://aimedalliance.org/dcs-prevention-campaign-significantly-decreased-hiv-infection-rates-past-decade/) - HIV rates in Washington, DC have significantly declined from a decade ago, holding the city as a model throughout the country in tackling the epidemic. With a goal to end the epidemic by 2020, the city has used aggressive strategies, including starting awareness campaigns, encouraging residents to get tested, implementing a needle exchange program, and
- [Health Insurer Intends To Help Stabilize Individual Marketplace Exchanges](https://aimedalliance.org/health-insurer-intends-help-stabilize-individual-marketplace-exchanges/) - Centene, a health insurer covering 1.1 million people in the Affordable Care Act marketplace, is working with state and federal officials to stabilize the individual market. The insurer reported higher earnings this quarter compared to last year, showing that it is possible for third-party payers to profit in the marketplaces. Read more here.
- [Aimed Alliance in Bloomberg: REMS Drug Program Keeps Patients Safe](https://aimedalliance.org/aimed-alliance-bloomberg-rems-drug-program-keeps-patients-safe/) - Aimed Alliance Executive Director, Stacey Worthy, was quoted in a Bloomberg article discussing the U.S. Food and Drug Administration’s Risk Evaluation and Mitigation Strategies (REMS) program. In the article, Ms. Worthy highlights the need for REMS safeguards to give patients access to innovative brand and generic drugs that would not otherwise be available. Read the
- [Conn. Bill Would Prevent Insurers from Dropping Meds After Plan Year Begins](https://aimedalliance.org/conn-bill-prevent-insurers-dropping-meds-plan-year-begins/) - Even though in most instances, plan enrollees cannot change their health plan once the plan year has begun, insurers can change its formulary benefits at any point. They may increase the out-of-pocket costs for a particular treatment or drop coverage of the treatment altogether, thereby forcing the plan enrollee to switch medications—a concept referred to
- [Lawsuit Shows PBM Pocketed Rebates for Opioid Overdose Reversal Drug](https://aimedalliance.org/lawsuit-shows-pbm-pocketed-rebates-opioid-overdose-reversal-drug/) - In a new lawsuit, a pharmacy benefit manager (PBM) alleges that a pharmaceutical company raised the price of its opioid overdose reversal medicine, naloxone, essentially price-gouging consumers. However, the lawsuit also shows that the PBM kept an increasing amount in rebates for itself, which the PBM reclassified as “administrative fees,” as the price of the
- [Major Insurer Announces ACA Exit in 2018](https://aimedalliance.org/major-insurer-announces-aca-exit-2018/) - Blue Cross and Blue Shield of Kansas City has announced that it will exit the Affordable Care Act exchange in 2018, citing lost profits and lack of sustainability. However, the insurer’s profits have been trending upward over the past three years. This will affect an estimated 67,000 customers in Missouri and Kansas, leaving consumers with
- [Hospitals Create Medical-Legal Partnerships To Help Patients with Legal Issues](https://aimedalliance.org/hospitals-create-medical-legal-partnerships-help-patients-legal-issues/) - As health care systems continue to shift toward becoming more comprehensive, hospitals and health care providers are increasingly incorporating lawyers into the team of professionals to help patients with legal issues that can cascade into health problems for no additional charge. Currently, about 300 health care systems, children’s hospitals, and federally qualified health centers have
- [Clinicians Need Help Providing Patients with Cancer with Out-of-Pocket Cost Estimates](https://aimedalliance.org/clinicians-need-help-providing-patients-cancer-pocket-cost-estimates/) - A new study presented the American Society of Clinical Oncology (ASCO) conference shows that clinicians need third-party support to provide patients with cancer accurate estimates of out-of-pocket costs and financial aid. They also require training on how to disclose personal and professional conflicts of interest to prevent harm to the provider-patient relationship. Read more here.
- [Aimed Alliance Op-Ed in The Hill Calls on Senate To Follow States’ Lead in Health Care Reform](https://aimedalliance.org/aimed-alliance-op-ed-hill-calls-senate-follow-states-lead-health-care-reform/) - The Hill has published an op-ed by Aimed Alliance’s Executive Director, Stacey L. Worthy. In the op-ed, Ms. Worthy calls on the U.S. Senate to look to states in developing its version of the American Health Care Act to ensure meaningful reform that puts consumers first. Important steps include preventing unfair use of formulary tiers
- [Aimed Alliance Addresses Significant Deficiencies in Study Claiming Misuse of Medication Safety Protocols](https://aimedalliance.org/aimed-alliance-addresses-significant-deficiencies-study-claiming-misuse-medication-safety-protocols/) - Aimed Alliance identified significant deficiencies in a new study by Matrix Global Advisors that aimed to put cost savings ahead of patient safety. The study claimed that Risk Evaluation and Mitigation Strategies (REMS) protocols used to ensure that medications with known and potential severe side effects are used safely, were being misused to block generic
- [Aimed Alliance Director Quoted in Modern Medicine Network Article on Addressing Increased Biosimilar Access](https://aimedalliance.org/aimed-alliance-director-quoted-modern-medicine-network-article-addressing-increased-biosimilar-access/) - Last week, Aimed Alliance Executive Director, Stacey L. Worthy, was quoted in an article in Modern Medicine Network, entitled Supreme Court Ruling Raises Biosimilars’ Access. The article notes that a recent Supreme Court decision allows biosimilar manufacturers to start advertising their drugs before they know the indications for which the U.S. Food and Drug Administration
- [CBO Report Says Senate Health Bill Would Leave 22 Million Uninsured](https://aimedalliance.org/cbo-report-says-senate-health-bill-leave-22-million-uninsured/) - According to a new Congressional Budget Office (CBO) report, the Senate bill to repeal the Affordable Care Act would result in 22 million Americans losing their health insurance by 2026. Read more here. For more reasonable health care reform, read Aimed Alliance’s paper, “Advancing Quality Health Care in the U.S.: A Roadmap for Consumer-Focused Reform” here.
- [Aimed Alliance Board Member Discusses Patient Access to Insurance Protection and Essential Health Benefits](https://aimedalliance.org/aimed-alliance-board-member-discusses-patient-access-insurance-protection-essential-health-benefits/) - Aimed Alliance board member, Michael Barnes, appeared on a network news segment to discuss the need for patients to not lose access to insurance protection and essential health benefits like maternity care, addiction treatment, and mental health treatment. This segment aired on June 30, 2017.
- [U.S. Senate Approves Bill Revamping Medicare for Chronically Ill Patients](https://aimedalliance.org/u-s-senate-approves-bill-revamping-medicare-chronically-ill-patients/) - The U.S. Senate Finance Committee has unanimously advanced a bill that would revamp how Medicare works for patients who have chronic medical conditions. The legislation is aimed at reducing costs associated with chronic illness by giving people greater access to telehealth services, promoting care coordination between providers, and expanding value-based payment models. The legislation still
- [Insurer Ends Test that Provided Unlimited Primary Care at No Charge](https://aimedalliance.org/insurer-ends-test-provided-unlimited-primary-care-no-charge/) - A health insurer is ending a health plan experiment that offered unlimited primary and behavioral care at no charge. Although the insurer will continue to cover individual-market enrollees through the end of the year and serve employer group members through the end of their contracts, they are giving up on value-based initiatives that can both
- [CBO Reports Amended AHCA Will Cause 23 Million To Lose Insurance](https://aimedalliance.org/cbo-reports-amended-ahca-will-cause-23-million-lose-insurance/) - The Congressional Budget Office (CBO) reports that under the MacArthur Amendment of the American Health Care Act (AHCA), 23 million more people will lose their insurance by 2026 compared to the current health care system. The CBO report also projects that the legislation would result in $32 billion less of a cut to the federal
- [Mass. State Rep. Introduces Legislation Targeting Step Therapy Policies](https://aimedalliance.org/mass-state-rep-introduces-legislation-targeting-step-therapy-policies/) - Massachusetts State Representative Jennifer Benson has introduced a bill that would require insurance companies in the state to respond to a step therapy appeal within 72 hours. Step therapy occurs after a doctor prescribes medication an insurance company may consider too new or expensive, forcing the patient to try other drugs that may not work
- [Conn. Nonmedical Switching Legislation Would Close Loophole](https://aimedalliance.org/conn-nonmedical-switching-legislation-close-loophole/) - Nonmedical switching legislation that was introduced in Connecticut this session with the support from a wide array of public health advocates, would protect Connecticut residents, especially those with chronic conditions. Connecticut House Bill 7123 would ensure that patients not have their health plan changed in the middle of a plan year and protect consumers from
- [Aimed Alliance Calls on Attorneys To Help Patients When Health Insurers Violate Their Rights](https://aimedalliance.org/aimed-alliance-publishes-new-journal-article-now-never/) - Aimed Alliance’s new journal article “Now or Never: The Urgent Need for Action Against Unfair Coverage Denials for Quality Health Care,” was published this June in the Loyola University Chicago Law Journal. The article calls on trial attorneys to help consumers challenge unethical, inefficient, and illegal insurance practices that require high out-of-pocket payments, delay access
- [Conn. Bill Would End Practice Forbidding Pharmacists To Disclose Drug Prices](https://aimedalliance.org/proposed-conn-legislation-eliminate-practice-forbidding-pharmacists-disclose-drug-prices/) - A proposed Connecticut bill would eliminate a pharmaceutical practice that allows pharmacy benefit managers (PBMs) to prohibit pharmacists from disclosing information about prescription costs to patients. CT S. 445 would ban the 'gag order' provisions found in many contracts between pharmacists and PBMs in Connecticut, putting patients before profits. Read more here, and read the bill
- [Discounts Intended for Patients Blocked by PBMs](https://aimedalliance.org/discounts-intended-patients-blocked-pbms/) - Pharmacy benefit managers (PBMs) still play a key role in driving up pharmaceutical prices and keeping discounts away from patients. PBMs work as the middlemen in the drug market, negotiating drug prices with pharmaceutical companies and determining which medicines are covered by plans at which co-payment or co-insurance levels. Increasing transparency in the PBM process
- [Celgene Says Treatments that Provide Greatest Health Impact Should Have Lowest Cost-Sharing Requirements](https://aimedalliance.org/lower-costs-eliminate-discriminatory-cost-sharing-hurdles-promote-new-medicines/) - Celgene's Chief Executive Officer Mark Alles notes that millions of patients continue to live because of new medicines, and treatments that provide the greatest health impact for seriously ill patients should have the lowest cost-sharing requirements. Patients must also be protected from health insurance company practices that delay or deny needed care, such as adverse
- [Former Baseball Player and Myeloma Patient Helps Cancer Patients with Online Campaign](https://aimedalliance.org/former-baseball-player-myeloma-patient-helps-cancer-patients-online-campaign/) - Robert Tufts, a former major league baseball player and multiple myeloma patient, has channeled his diagnosis into helping other patients with cancer by co-founding the online campaign My Life is Worth It. The campaign advocates for patient and doctor access to choices in medications, while encouraging patients to utilize teaching hospitals and optimize time with
- [Patients with Rare Diseases Face Insurer Barriers that Can Limit Treatment](https://aimedalliance.org/patients-rare-diseases-face-insurer-barriers-can-limit-treatment/) - Patients with rare diseases or preexisting conditions have faced increasing difficulty getting their health insurers to approve treatments, whether through treatment interruption or through treatment denial. Insurance companies sometimes requires patients to stop taking their medications or undergo new lab work to demonstrate they still need it after being prescribed certain medications. Read more here.
- [Aimed Alliance Director of Medical Affairs Discusses Knowing Your Health Insurance Rights](https://aimedalliance.org/aimed-alliance-director-medical-affairs-discusses-knowing-health-insurance-rights/) - Aimed Alliance Director of Medical Affairs, Shannon Ginnan, M.D., discusses the rights patients should know they have against health insurers who use tactics to deny treatment claims or refuse to cover doctor prescribed medications. Such tactics include step therapy, adverse tiering, nonmedical switching, and prior authorization, and can violate state or federal laws. To learn
- [Nev. Gov. Stops Bill that Could Have Unintentionally Raised Health Care Prices](https://aimedalliance.org/nev-gov-vetoes-bill-ignored-pbms-unintentionally-raised-health-care-prices/) - Nevada Governor Brian Sandoval has written a letter vetoing a transparency bill that could have limited care while increasing prices. According to the Governor, Senate Bill 265 would have ignored the role pharmacy benefit managers (PBMs) have in creating health care prices while providing purchasers, wholesalers, and secondary distributors of health care products a financial
- [Celgene Says U.S. Must Rethink How Patients Pay for Cancer Care To Ensure Accessibility](https://aimedalliance.org/celgene-says-u-s-must-rethink-patients-pay-cancer-care-ensure-accessibility/) - Celgene Chief Executive Officer Mark Alles discusses how the United States must rethink the way cancer patients pay for care at this week’s American Society of Clinical Oncology (ASCO) conference. Industry leaders must be engaged with political leaders to ensure that the most important medicines for the sickest patients are affordable and accessible, given that
- [Hasty Legislation Could Endanger Patients' Lives and Sacrifice Safeguards](https://aimedalliance.org/hasty-legislation-endanger-patients-lives-sacrifice-safeguards/) - Peter Pitts of the Center for Medicine in the Public Interest, notes that under the CREATES and FAST Acts, potent medicines could fall into the wrong hands without adequate safeguards for patients. Congress could help consumers by reworking the legislative language to end bad behavior without gutting safeguards for patients or enabling unscrupulous trial lawyers
- [Mass. To Create Online Guide To Help Consumers Make Educated Choices about Health Care](https://aimedalliance.org/mass-create-online-guide-help-consumers-make-educated-choices-health-care/) - Massachusetts’s Center for Health Information and Analysis has started the process of launching a user-friendly website that includes the average prices of dozens of common health care procedures, safety and quality measures for individual hospitals, and basic information about obtaining insurance and getting care. Part of the goal of the site is to get patients
- [CMS To Limit Role in Ensuring Exchange Plans Comply with ACA Requirements](https://aimedalliance.org/cms-limit-role-ensuring-exchange-plans-comply-aca-requirements/) - Under new regulations, Centers for Medicare and Medicaid Services (CMS) will begin to limit its role in making sure exchange plans comply with certain Affordable Care Act (ACA) requirements – including reviews for prescription drug benefits – beginning in 2018. The changes came in a final rule last week, and could mean that in states
- [Aimed Alliance’s Executive Director To Present at 2017 Rx Summit](https://aimedalliance.org/aimed-alliances-executive-director-stacey-worthy-present-2017-rx-summit/) - Aimed Alliance’s Executive Director, Stacey Worthy, will be speaking at the 2017 Rx Drug Abuse & Heroin Summit panel “Improving Access and Eliminating Fraud, Waste and Abuse.” Panelists will examine improving access to treatment and quality care by eliminating waste, fraud, and abuse in addiction treatment. Ms. Worthy will discuss bad actors among new clinics
- [Under MedPAC Recommendation, the Nation’s Cancer Care System Will Suffer](https://aimedalliance.org/medpac-recommendation-nations-cancer-care-system-will-suffer/) - The Medicare Payment Advisory Commission (MedPAC) voted earlier this month to recommend Congress change the way drugs are paid for under Medicare Part B. The proposal would drop payments over wholesale cost to three percent in 2018 as well as introduce a drug formulary whose prices have been negotiated by third-party vendors. The MedPAC recommendations
- [PBMs Could Be Charging Patients More than Their Medicine Costs](https://aimedalliance.org/pbms-charging-patients-medicine-costs/) - Middlemen could be causing patients to overpay medicines by negotiating prescription drug prices and retaining the price difference owed to pharmacies. These middlemen or pharmacy benefit managers (PBMs), act as negotiators between insurance companies and pharmacists to process prescriptions by negotiating with drug manufacturers and handling patient claims. Pharmacies are prohibited from talking to patients
- [Patient Power Interviews Aimed Alliance about Getting Access to Needed Medicines](https://aimedalliance.org/aimed-alliance-andrew-schorr-patient-power-discusses-fight-insurance-companies-get-access-needed-medicines/) - On April 28, 2017, Patient Power interviewed Aimed Alliance Executive Director Stacey Worthy about access to medicine.
- [Proposed HI Legislation Would Hold Insurers Liable for Patient Injuries Caused by Preauthorization Delays](https://aimedalliance.org/proposed-hi-legislation-hold-insurers-liable-patient-injuries-caused-preauthorization-delays/) - Legislation has been introduced in the Hawaii House that would ensure prior authorization requirements do not negatively impact patients. The bill, HI HB 885, would prohibit health insurance companies from creating preauthorization requirements that cause undue delay in receipt of medical treatment or services, and would specify that insurers are liable for civil damages caused
- [DOJ Intervenes in False Claims Act Lawsuit Against Insurer for Mischarging Medicare Programs](https://aimedalliance.org/doj-intervenes-false-claims-act-lawsuit-insurer-mischarging-medicare-programs/) - The U.S. has intervened and filed a complaint in a lawsuit against an insurer that alleges it obtained inflated risk adjustment payments based on untruthful and inaccurate information about the health status of beneficiaries enrolled in a Medicare Advantage Plan. This is the government’s first-ever False Claims Act (FCA) complaint in a whistleblower-led suit alleging Medicare Advantage
- [Advocates Provide Tips for Seniors Appealing Medicare Drug Plan Denials](https://aimedalliance.org/advocates-provide-tips-seniors-appealing-medicare-drug-plan-denials/) - With many older adults unsure of how to appeal Medicare drug plan denials, advocates provide recommendations for navigating an appeals process. Such recommendations include getting a written statement from physicians regarding particular medications, keeping careful details about medical visits and communications with health care professionals, and maintaining records of any out-of-pocket drug expenses. Read more
- [Aimed Alliance Board Member Discusses Shortcomings of GOP Health Care Bill on CNBC](https://aimedalliance.org/aimed-alliance-board-member-discusses-shortcomings-gop-health-care-bill-cnbc/) - On May 4, 2017, Aimed Alliance board member, Michael Barnes, appeared on CNBC to discuss the shortcomings of the proposed GOP health care bill, the American Health Care Act. Mr. Barnes explained how the coverage protections available under the Affordable Care Act would be gutted under the proposed law, including charging more for pre-existing conditions
- [Prior Authorization Impedes Patient Access](https://aimedalliance.org/prior-authorization-major-impediment-patient-access/) - Efforts by physicians to ensure patient access to the most appropriate treatment can often be at odds with the financial interests of payers and their stakeholders, through a process known as prior authorization. In a survey by the American Medical Association, more than 50 percent of physicians reported experiencing a 20 percent rejection rate from
- [Report Highlights that U.S. is Spending Less on Medicines](https://aimedalliance.org/report-highlights-u-s-spending-less-medicines/) - A new report on medicines and their use in the U.S. indicates that spending on medicines fell in 2016 as competition intensified, with spending only growing 4.8 percent in 2016 and brand-name medicine prices only increasing 3.5 percent after accounting for negotiated discounts and rebates. The report also found that more than half of commercial
- [TX Legislation Ensures Patients with Ongoing Medical Conditions Receive Ongoing Insurance Coverage](https://aimedalliance.org/tx-legislation-ensures-patients-ongoing-medical-conditions-receive-ongoing-insurance-coverage/) - Two bills currently before the Texas legislature will make sure doctors – not insurance companies – decide what treatments patients receive. House Bill 2882 and Senate Bill 1967 would extend protection against nonmedical switching for as long as policyholders pay their monthly premiums. The legislation ensures that patients with ongoing conditions receive the ongoing coverage
- [Questions To Ask To Find Out Your Medical Costs](https://aimedalliance.org/questions-ask-find-medical-costs/) - Whether insured or uninsured, learning the right questions to ask regarding how much a medical procedure will cost can help prevent surprise medical bills. Some specific questions to ask include asking what the cash or self-pay price is, what the cost for the procedure is under insurance, and how the cost is determined. To learn
- [NJ. Gov. Pushes for Greater Insurer Focus on Public Interest](https://aimedalliance.org/nj-gov-chris-christie-wants-control-state-health-insurer/) - New Jersey Governor Chris Christie is calling for greater non-profit insurer focus on public interest and accountability. Excessive spending on lobbying and salaries have contributed to higher insurance costs, while insurers continue to deny care. The governor, who is on President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis, has also made addressing
- [Federal Government Alleges Insurer Overcharged U.S. by $1 Billion](https://aimedalliance.org/federal-government-alleges-insurer-overcharged-u-s-1-billion/) - The U.S. Justice Department accused a health insurer of overcharging the federal government by more than $1 billion through its Medicare Advantage plans earlier this week. The lawsuit alleges that the insurer made patients appear sicker than they were in order to collect higher Medicare payments than it deserved. Read more here.
- [Laws and Sensible Policies Together Can Improve Rational Prescribing](https://aimedalliance.org/laws-sensible-policies-together-can-improve-rational-prescribing/) - Several states have passed laws limiting insurers’ ability to require step therapy, but questions remain about whether such legislation can successfully address the problems that motivate step therapy policies or their resulting problems. Transparent, evidence-based policies that restrict the use of step therapy along with increased physician education may all be viable options, but perhaps
- [When Is It Acceptable for Patients with the Same Condition To Pay Different Out-of-Pocket Costs?](https://aimedalliance.org/acceptable-patients-condition-pay-different-pocket-costs/) - The National Pharmaceutical Council published a recent study on principles it says should guide when it is and is not acceptable for patients with the same condition to pay different out-of-pocket (OOP) costs. The study identified five guiding principles to determine when it was more or less acceptable for patients to have different OOP costs,
- [Personalized Medicine Has Potential To Transform Treatment](https://aimedalliance.org/personalized-medicine-potential-transform-treatment/) - Personalized medicine, which involves tailoring health care to each person’s unique genetic makeup, has the potential to transform how diseases are diagnosed, prevented and treated. Despite limitations to the ability of genomic medicine to transform health care, medicine in the future should unquestionably aspire to be personal and holistic – in the context of a
- [Proposed Ariz. Bill Would Create a Process To Help Consumers with Unexpected Medical Bills](https://aimedalliance.org/proposed-ariz-bill-create-process-help-consumers-unexpected-medical-bills/) - The Arizona legislature proposed a bill last week to help health care consumers who have been stung by surprise medical bills. The problem occurs when a consumer seeks care after checking to be sure a doctor, clinic or hospital is part of their insurance company's network — only to be billed later by out-of-network providers
- [Researchers Find Ways To Help Patients Be More Confident about Medical Decisions](https://aimedalliance.org/researchers-find-ways-help-patients-confident-medical-decisions/) - Researchers and health care providers say they are figuring out how to get patients to take charge of their own health by designing decision aids, offering patients full access to their own medical records, and training doctors to help guide patients to make informed choices. While data is limited on how shared decision making affects
- [Allowing Imported Drugs Could Be Dangerous](https://aimedalliance.org/allowing-imported-drugs-dangerous/) - Some members of Congress want to open up the pharmaceutical market to imported medicines, ignoring the potential outcome Maine faced when it did the same thing four years ago. In 2013, Maine legalized the importation of foreign drugs, until it was discovered that some of the imported drugs were inferior to U.S. standards. Legislators claim
- [Pharmacists Are Being Barred from Disclosing Drug Costs](https://aimedalliance.org/pharmacists-barred-disclosing-drug-costs/) - Many pharmacists are barred from disclosing to patients that co-pays for generic medicines are sometimes more expensive than paying out-of-pocket due to gag clauses in their contracts. The extra money, called clawbacks – higher prices negotiated by pharmacy benefit managers (PBMs) – can increase profits for PMBs while patients pay more and have prompted multiple
- [Though Improving, Cancer Drug Coverage Under ACA Has Room for Improvement](https://aimedalliance.org/though-improving-cancer-drug-coverage-aca-room-improvement/) - Analysis done by the American Cancer Society Cancer Action Network (ACS CAN) in six states, reports that coverage transparency has improved since 2015 but it is still hard for consumers to determine prescription drug coverage and cost-sharing information in Affordable Care Act (ACA) marketplace plans. The report found that patient cost-sharing is high, and coverage
- [Calif. Insurer Proposes Plan that Urges Consumers To Pick “Preferred” Pharmacies](https://aimedalliance.org/calif-insurer-proposes-plan-urges-consumers-pick-preferred-pharmacies/) - One of California’s insurers has proposed a change of its commercial plans that would urge consumers to pick “preferred” pharmacies. A California insurer aims to create a tiered network of pharmacies with “preferred” ones that would maintain the current year’s copayment amount in an effort to lower costs, creating a more narrow pharmacy network. Read
- [CBO Estimates that 24 Million Would Lose Coverage by 2026 Under GOP Health Care Plan](https://aimedalliance.org/cbo-estimates-24-million-lose-coverage-2026-gop-health-care-plan/) - The Congressional Budget Office (CBO) estimates that 14 million people would become uninsured next year if the new GOP health care plan was signed into law – a projected loss of about 70 percent of the roughly 20 million people who have gained insurance as a result of the Affordable Care Act (ACA). Furthermore, in
- [How To Get Patients More Involved in Their Care](https://aimedalliance.org/get-patients-involved-care/) - Researchers and health care providers are figuring out how to get patients to take charge of their own health by creating decision aids, offering patients full access to their medical records, and training doctors to guide patients to make informed choices. Studies have shown that shared doctor-patient decision making creates better health care outcomes, fewer
- [Aimed Alliance Featured in Morning Consult: “Administration’s Proposed ACA Rules Create Loopholes for Discrimination”](https://aimedalliance.org/aimed-alliances-op-ed-featured-morning-consult-administrations-proposed-aca-rules-create-legal-loopholes-discrimination/) - Morning Consult has published an op-ed by Aimed Alliance’s Executive Director, Stacey L. Worthy. The op-ed discusses a proposed rule from the Department of Health and Human Services (HHS) that would give insurers new regulatory loopholes within the Affordable Care Act (ACA). HHS proposes to cut the open enrollment period, get rid of “guaranteed availability”
- [Reducing Out-of-Pocket Costs for Part D Could Create Better Access to Treatment](https://aimedalliance.org/reducing-pocket-costs-part-d-create-better-access-treatment/) - A new study has analyzed proposed policies that would affect out-of-pocket prescription costs for Medicare Part D beneficiaries requiring specialty drugs who did not qualify for low-income subsidies. The study recommended implementing annual and monthly out-of-pocket spending limits that would create lower, more consistent costs, potentially increasing patients’ ability to access treatments for life-threatening, chronic,
- [Health Experts Devise Plan To Eliminate Hep. B and C from U.S. by 2030](https://aimedalliance.org/health-experts-devise-plan-eliminate-hep-b-c-u-s-2030/) - An expert panel from the National Academies of Science, Engineering, and Medicine Health has devised a plan to eliminate two types of hepatitis by 2030 by persuading the federal government to purchase the rights to one or more of the costly new medications that can essentially cure hepatitis C. The panel also recommended a campaign
- [Drug Importation from Canada Increases Patient Risk with No Guarantee of Lower Prices](https://aimedalliance.org/drug-importation-canada-increases-patient-risk-no-guarantee-lower-prices/) - A new proposal to reduce the price Americans have to pay for medicines by importing medicines from Canada overlooks patient risks that will not outweigh any potential cost savings. There is also no system to assure the safety and quality of medicine that was not intended for the U.S. market if is it exported to
- [Aimed Alliance Op-Ed Featured in Real Clear Health Discussing Pharmacy Benefit Managers](https://aimedalliance.org/aimed-alliances-op-ed-featured-real-clear-health-another-sneaky-pbm-practice-needs-end/) - Real Clear Health has published an op-ed by Aimed Alliance’s Executive Director Stacey L. Worthy. The op-ed discusses pharmacy benefit manager (PBM) practices of nonmedical switching, the practice of forcing patients who are well managed on a therapy to take a less costly and possibly less effective drug for nonmedical reasons. The op-ed calls on
- [Aimed Alliance To Participate in Finely Tuned Twitter Chat](https://aimedalliance.org/aimed-alliance-participate-finely-tuned-twitter-chat/) - Aimed Alliance’s Executive Director, Stacey L. Worthy, will be participating in a Finely Tuned Twitter chat “Being your Own Advocate in Treatment Decision.” The chat will be a discussion about talking openly with doctors to have a voice in treatment options. The chat will be on April 13 at 7:00 PM EST. Click here for
- [States Fail Hep C Patients by Falling Short on CMS Guidelines](https://aimedalliance.org/states-fail-hep-c-patients-falling-short-cms-guidelines/) - A new report shows that state Medicaid programs are failing to meet Centers for Medicare and Medicaid Services (CMS) guidelines on access to hepatitis c treatments and may be violating federal law in doing so. While many states have removed restrictions requiring patients to have advanced liver damage, they still require patients to see a
- [Insurer Sued on Allegations of Hidden Fees & Gag Clauses](https://aimedalliance.org/insurer-sued-allegations-hidden-fees-gag-clauses/) - Plan participants have sued an insurer for overcharging for prescription medications. The plaintiffs allege that the insurer charged "hidden bogus fees" and employed "gag clauses," which required pharmacists not to tell their patients how much their prescriptions actually cost and prohibited them from providing lower-cost alternatives to patients. More here.
- [The Problem Is Not the Affordable Care Act, but the Insurance Companies](https://aimedalliance.org/problem-not-affordable-care-act-insurance-companies/) - A Maine health care provider suggests that the treatment delays and high costs of health care is not the fault of the Affordable Care Act, but the fault of insurance companies. The health care provider suggests that care should be contracted straight with patients to provide care, instead of going through insurance companies to get
- [Hospital Associations Warn of Public Health Crisis if ACA is Repealed](https://aimedalliance.org/hospital-associations-warn-public-health-crisis-aca-repealed/) - Two hospital associations have warned the new administration and congressional leaders that repeal of the Affordable Care Act could result in an unprecedented public health crisis, including a $165 billion loss for hospitals nationwide. They fear a surge of uninsured patients who will need services they can’t afford. Read more here.
- [Congress Passes 21st Century Cures Act: A Major Victory for Patients](https://aimedalliance.org/congress-passes-21st-century-cures-act-major-victory-patients/) - Today, Congress passed the landmark 21st Century Cures Act, which aims to improve health care for pregnant women, children with diabetes, and individuals with chronic conditions, including mental health and substance use disorders. The Act also provides funding for major research initiatives at the National Institutes of Health, including Cancer Moonshot. More here.
- [The Future of the ACA](https://aimedalliance.org/the-future-of-the-aca/) - In its sixth and possibly final year, the Patient Protection and Affordable Care Act (ACA) has had successes and failures. This article provides a comprehensive outlook on both and describes the impact of repealing and replacing the ACA on the health care industry. More here.
- [Repealing the ACA Could be ‘Akin to Armageddon’ for People with Mental Health and Substance Use Disorders](https://aimedalliance.org/repealing-aca-akin-armageddon-people-mental-health-substance-use-disorders/) - The Patient Protection and Affordable Care Act (ACA) includes mental health as an “essential benefit” that insurers must cover at the same level as other medical care for the 20 million people covered under the ACA’s exchanges and Medicaid expansion. A full repeal of the ACA could leave millions of Americans with mental health and
- [Aimed Alliance Launches Know Your Health Insurance Rights Online Tool](https://aimedalliance.org/aimed-alliance-launches-know-health-insurance-rights-online-tool/) - The initiative helps patients in each state walk through the appeals process if their health insurer delayed or refused to cover their prescribed treatments or services. Find information about your state here. Read more about the initiative here.
- [Aimed Alliance To Moderate Panel on Future of Value Based Pricing Initiatives at 2016 FDA/CMS Summit](https://aimedalliance.org/aimed-alliance-moderate-panel-future-value-based-pricing-initiatives-2016-fdacms-summit/) - Aimed Alliance’s Executive Director, Stacey Worthy, will moderate a panel discussion entitled “The Future of Value Based Pricing Initiatives” at the 2016 FDA/CMS Summit on December 14, 2016. Panelists will discuss the challenges, opportunities, and innovations around value-based initiatives and how they impact patients. For more info, read here: https://lifesciences.knect365.com/fda-cms/agenda/1.
- [Aimed Alliance’s Op-Ed Featured in The Hill: “New Poll Reveals Americans Don’t Want Insurers To Limit Treatment Decisions”](https://aimedalliance.org/aimed-alliances-op-ed-featured-hill-new-poll-reveals-americans-dont-want-insurers-limit-treatment-decisions/) - The Hill has published an op-ed by Aimed Alliance’s Executive Director, Stacey L. Worthy. The op-ed discusses Aimed Alliance’s newly released poll “Principles of U.S. Health Care,” which reveals a disconnect between expectations and reality when it comes to the high standards to which Americans hold their health insurers. The poll also reveals that Americans

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- [Copay Accumulators - Enacted Laws](https://aimedalliance.org/copay-accumulators-enacted-laws/) - When patients cannot afford their medications, they may rely on financial assistance from pharmaceutical manufacturers and other third parties to meet their health plan’s cost-sharing responsibilities and fill their prescriptions. The value of this financial assistance typically counts toward the health plan’s deductible or maximum out-of-pocket limit, unless the health plan has implemented a copay
- [Oral Parity-Enacted Laws](https://aimedalliance.org/oral-parity-enacted-laws/) - For many patients with cancer, intravenous chemotherapy treatments can be uncomfortable and inconvenient, as they require patients to leave the comfort of their homes to visit their clinician’s office. In recent years, alternatives to infused therapeutic treatments have begun to emerge and oral treatments have become more popular. Oral treatments allow patients to take the
- [Biomarker Testing - Enacted Laws](https://aimedalliance.org/biomarker-testing-enacted-laws/) - Biomarkers testing can be used to identify genes, proteins, or other substances that provide information about a person's cancer. This testing provides important information that can help health care providers select and monitor appropriate treatments, which helps providers develop a more personalized treatment plan for patients. However, both public and private health plans do not
- [Biomarker Testing - Active Legislation](https://aimedalliance.org/biomarker-testing-active-legislation/) - Biomarkers testing can be used to identify genes, proteins, or other substances that provide information about a person's cancer. This testing provides important information that can help health care providers select and monitor appropriate treatments, which helps providers develop a more personalized treatment plan for patients. However, both public and private health plans do not
- [Nonmedical Switching - Enacted Laws](https://aimedalliance.org/nonmedical-switching-enacted-laws/) - Nonmedical switching occurs when a health insurer requires a stable patient to switch from his or her current, effective medication to an alternative drug by excluding the original medication from coverage, elevating the drug to a higher cost tier, or otherwise limiting access to a treatment or increasing the patient’s out-of-pocket costs. Forcing a patient
- [Nonmedical Switching - Active Legislation](https://aimedalliance.org/nonmedical-switching-active-legislation/) - Nonmedical switching occurs when a health insurer requires a stable patient to switch from his or her current, effective medication to an alternative drug by excluding the original medication from coverage, elevating the drug to a higher cost tier, or otherwise limiting access to a treatment or increasing the patient’s out-of-pocket costs. Forcing a patient
- [Step Therapy - Enacted Laws](https://aimedalliance.org/step-therapy-enacted-laws/) - Step therapy policies, also referred to as “fail first,” require insured individuals to try and fail on alternative treatments, sometimes with adverse effects, before the insurer or pharmacy benefit manager will cover the prescribed treatment. Step therapy policies can be unethical and inconsistent with sound scientific and clinical evidence, resulting in interference with the practitioner-patient
- [Step Therapy - Active Legislation](https://aimedalliance.org/step-therapy-active-legislation/) - Step therapy policies, also referred to as “fail first,” require insured individuals to try and fail on alternative treatments, sometimes with adverse effects, before the insurer or pharmacy benefit manager will cover the prescribed treatment. Step therapy policies can be unethical and inconsistent with sound scientific and clinical evidence, resulting in interference with the practitioner-patient
- [Prior Authorization - Enacted Laws](https://aimedalliance.org/prior-authorization-enacted-laws/) - Prior authorization policies require a health care provider or an insurance plan enrollee to obtain approval from the insurer or its pharmacy benefit manager before the plan will cover the cost of a health care product or service. This practice can delay access to life-saving treatments and can be applied in a manner that is
- [Prior Authorization - Active Legislation](https://aimedalliance.org/prior-authorization-active-legislation/) - Prior authorization policies require a health care provider or an insurance plan enrollee to obtain approval from the insurer or its pharmacy benefit manager before the plan will cover the cost of a health care product or service. This practice can delay access to life-saving treatments and can be applied in a manner that is
- [Copay Accumulators - Active Legislation](https://aimedalliance.org/copay-accumulators-active-legislation/) - When patients cannot afford their medications, they may rely on financial assistance from pharmaceutical manufacturers and other third parties to meet their health plan’s cost-sharing responsibilities and fill their prescriptions. The value of this financial assistance typically counts toward the health plan’s deductible or maximum out-of-pocket limit, unless the health plan has implemented a copay
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- [Cannabinoid - Active Legislation](https://aimedalliance.org/cannabinoid-active-legislation/) - Food and supplement products containing cannabidiol (CBD) have risen in popularity over the past few years and have been misleadingly marketed as a cure-all for many medical conditions, including cancer, epilepsy, anxiety, depression, insomnia, pain, and diabetes. At the same time, there is mounting pressure to legalize non-prescription CBD products, which may pose significant safety
- [Advocacy Briefing: S.3257 to Facilitate Access to Medication for Opioid Use Disorder (MOUD)](https://aimedalliance.org/advocacy-briefing-s-3257-to-facilitate-access-to-medication-for-opioid-use-disorder-moud/)
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- [Health Insurance Matters Glossary of Terms](https://aimedalliance.org/health-insurance-matters-glossary/) - Below is a glossary of commonly used terms related to health plans, coverage, and access to care.* For a downloadable version of this glossary of terms, click here. A Access The ability of a patient or patient population to obtain or receive a particular treatment, medical service, or care. Adverse Tiering The practice in which
- [Innovation](https://aimedalliance.org/innovation/)
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- [Bad Drug Ads - Enacted Laws](https://aimedalliance.org/bad-drug-ads-enacted-laws/) - Personal injury law firms create ads to persuade viewers to join class action lawsuits against drug makers, but the misleading nature of these ads can have harmful consequences. The ads often contain frightening warnings about medications or devices causing serious injuries. They may be accompanied by jarring images, such as toe tags and body bags.
- [Bad Drug Ads - Active Legislation](https://aimedalliance.org/bad-drug-ads-active-legislation/) - Personal injury law firms create ads to persuade viewers to join class action lawsuits against drug makers, but the misleading nature of these ads can have harmful consequences. The ads often contain frightening warnings about medications or devices causing serious injuries. They may be accompanied by jarring images, such as toe tags and body bags.
- [Drug Pricing](https://aimedalliance.org/drug-pricing/)
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- [J. Kevin Massey](https://aimedalliance.org/j-kevin-massey/) - J. Kevin Massey is CEO of the Arlington Consulting Group, which provides healthcare technology innovation, quality improvement, strategy and program development/support, and is a subject matter expert on prescription drug abuse, misuse, diversion, safety, and utilization. For over 25 years, Mr. Massey has served in management, executive and consulting capacities in the fields of public
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- [Shari A. Hicks, CPhT](https://aimedalliance.org/shari-a-hicks-cpht/) - Shari A. Hicks, CPhT, is a nationally-certified pharmacy technician and currently serves as the Insurance Coordinator and Patient Advocate for Miller Care Group in Indianapolis, Indiana. In this role, Ms. Hicks works to ensure that individuals obtain the treatments their health care providers deem medically necessary. She also has extensive experience in a variety of
- [Eifer Lyddane](https://aimedalliance.org/eifer-lyddane/) - Eifer Lyddane is the Founder and CEO of In Good Company Wellness, a provider of health and wellness services to employers, communities, and individuals across the U.S. With over 15 years of experience as a personal trainer, health coach, and yoga instructor, Ms. Lyddane has witnessed firsthand how the integration of mind, body, and nutrition
- [Commercial Collaborators Privacy Policy](https://aimedalliance.org/privacy-policy/) - Aimed Alliance is committed to the privacy of its commercial collaborators. As such, Aimed Alliance shall not sell, share, or trade its commercial collaborators' names or personal information with any other entity or send mailings to its commercial collaborators on behalf of other organizations, except as required by law or unless Aimed Alliance obtains express
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- [Shannon Ginnan, MD](https://aimedalliance.org/staff-ginnan/) - As Director of Medical Affairs for Aimed Alliance, Dr. Shannon Ginnan provides the organization and its partners valuable insight from a practitioner’s perspective and serves as a liaison to the medical and health care technology communities. Dr. Ginnan is currently the Medical Director of an integrative medicine and hyperbaric medicine clinic, where he focuses on
- [Nonmedical Switching](https://aimedalliance.org/nonmedical-switching/)
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- [Providers](https://aimedalliance.org/providers/) - Know Your Patients’ Rights Health insurers’ policies to reduce costs, such as step therapy, prior authorization, and nonmedical switching, often interfere with health care providers’ treatment decisions. As a result, not only do such policies delay or prevent patients from accessing their prescribed care, but they also hinder providers’ ability to obtain payment and create

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- [Biomarkers](https://aimedalliance.org/category/biomarkers/)
- [Vaccines](https://aimedalliance.org/category/vaccines/)
- [OUD](https://aimedalliance.org/category/oud/)
- [Women's Health](https://aimedalliance.org/category/womens-health/)
- [Medicare Reform](https://aimedalliance.org/category/medicare-reform/)
- [Artificial Intelligence](https://aimedalliance.org/category/artificial-intelligence/)
- [Judicial Advocacy](https://aimedalliance.org/category/judicial-advocacy/)

## Tags

- [Nonmedical Switching](https://aimedalliance.org/tag/nonmedical-switching/)
- [State](https://aimedalliance.org/tag/state/)
- [Advocacy](https://aimedalliance.org/tag/advocacy/)
- [Health News](https://aimedalliance.org/tag/health-news/)
- [Step Therapy](https://aimedalliance.org/tag/step-therapy/)
- [Affordable Care Act](https://aimedalliance.org/tag/affordable-care-act/)
- [Federal](https://aimedalliance.org/tag/federal/)
- [Surprise Medical Bills](https://aimedalliance.org/tag/surprise-medical-bills/)
- [Education](https://aimedalliance.org/tag/education/)
- [Media](https://aimedalliance.org/tag/media/)
- [Migraine](https://aimedalliance.org/tag/migraine/)
- [Health Reform](https://aimedalliance.org/tag/health-reform/)
- [Medicaid](https://aimedalliance.org/tag/medicaid/)
- [Copay Accumulators](https://aimedalliance.org/tag/copay-accumulators/)
- [Medicare](https://aimedalliance.org/tag/medicare/)
- [Pharmacy Benefit Managers](https://aimedalliance.org/tag/pharmacy-benefit-managers/)
- [Rebates](https://aimedalliance.org/tag/rebates/)
- [Junk Plans](https://aimedalliance.org/tag/junk-plans/)
- [Employers](https://aimedalliance.org/tag/employers/)
- [Multimedia](https://aimedalliance.org/tag/multimedia/)
- [Events](https://aimedalliance.org/tag/events/)
- [Cancer](https://aimedalliance.org/tag/cancer/)
- [Transparency](https://aimedalliance.org/tag/transparency/)
- [Research/Data](https://aimedalliance.org/tag/research-data/)
- [Prior Authorization](https://aimedalliance.org/tag/prior-authorization/)
- [Survey/Poll](https://aimedalliance.org/tag/survey-poll/)
- [Thought Leadership](https://aimedalliance.org/tag/thought-leadership/)
- [Value](https://aimedalliance.org/tag/value/)
- [FDA](https://aimedalliance.org/tag/fda/)
- [Safety](https://aimedalliance.org/tag/safety/)
- [Administrative](https://aimedalliance.org/tag/administrative/)
- [EPIC](https://aimedalliance.org/tag/epic/)
- [Discrimination](https://aimedalliance.org/tag/discrimination/)
- [CBD](https://aimedalliance.org/tag/cbd/)
- [Cannabis](https://aimedalliance.org/tag/cannabis/)
- [Legal](https://aimedalliance.org/tag/legal/)
- [Lawsuit](https://aimedalliance.org/tag/lawsuit/)
- [HHS](https://aimedalliance.org/tag/hhs/)
- [OIG](https://aimedalliance.org/tag/oig/)
- [Hospital](https://aimedalliance.org/tag/hospital/)
- [Patient](https://aimedalliance.org/tag/patient/)
- [Cost of Living](https://aimedalliance.org/tag/cost-of-living/)
- [Health Care](https://aimedalliance.org/tag/health-care/)
- [ACA](https://aimedalliance.org/tag/aca/)
- [Annual Report](https://aimedalliance.org/tag/annual-report/)
- [Privacy](https://aimedalliance.org/tag/privacy/)
- [NBPP](https://aimedalliance.org/tag/nbpp/)
- [DOL](https://aimedalliance.org/tag/dol/)
- [IRS](https://aimedalliance.org/tag/irs/)
- [Dietary Supplements](https://aimedalliance.org/tag/dietary-supplements/)
- [Drug Pricing](https://aimedalliance.org/tag/drug-pricing/)
- [PBMs](https://aimedalliance.org/tag/pbms/)
- [Report](https://aimedalliance.org/tag/report/)
- [Survey](https://aimedalliance.org/tag/survey/)
- [International](https://aimedalliance.org/tag/international/)
- [Coronavirus](https://aimedalliance.org/tag/coronavirus/)
- [Access](https://aimedalliance.org/tag/access/)
- [Insurance](https://aimedalliance.org/tag/insurance/)
- [FTC](https://aimedalliance.org/tag/ftc/)
- [Biosimilars](https://aimedalliance.org/tag/biosimilars/)
- [COVID19](https://aimedalliance.org/tag/covid19/)
- [CMS](https://aimedalliance.org/tag/cms/)
- [Health Care Rights](https://aimedalliance.org/tag/health-care-rights/)