Many Ohioans lack access to prescription medications because insurers and pharmacy benefit managers are increasingly making it more difficult for patients to afford them. High-deductible health plans, copayments, coinsurance, copay accumulators, restrictive formularies, etc. are all tactics used to simply push more of the cost-share onto the patient.

New Analysis: ICER Framework Ignores Patient Preferences, Innovation & Societal Benefits in Evaluating Cost-Effectiveness of New Cancer Treatments

New Analysis: ICER Framework Ignores Patient Preferences, Innovation & Societal Benefits in Evaluating Cost-Effectiveness of New Cancer Treatments
April 7, 2021

Policymakers Should Ban the Use of the Quality Adjusted Life Years (QALY) Methodology in Evaluating New Cancer Therapies & Prohibit ICER from Advising Government Agencies Media inquiries: Contact Micaela Dawson, mdawson @pioneerinstitute .org Boston – Pioneer Institute today released a new analysis, The QALY and Cancer Treatments: An Ill-Advised Match, that examines the alarming methodological and contextual shortcomings of…

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Trump, Biden Medicare Moves Need Fixing

Trump, Biden Medicare Moves Need Fixing
March 4, 2021

By PATRICK J. KENNEDY | March 4, 2021 at 5:16 a.m. On Donald Trump’s last full day in office, his administration announced a policy change that would make it easier for insurers to deny medicine to vulnerable Medicare beneficiaries. Those most affected will include people with mental health disorders, a group that already faces major roadblocks —…

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Manchester, West introduce Patient Protection legislation

Manchester, West introduce Patient Protection legislation
March 3, 2021

  COLUMBUS – State Representatives Susan Manchester (R-Waynesfield) and Thomas West (D-Canton) recently introduced House Bill 135, which would cut out-of-pocket prescription drug costs for patients. The legislation is supported by a large coalition of patient advocate and healthcare provider organizations. Some patients with chronic, complex conditions such as multiple sclerosis and hemophilia rely on…

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How a quiet co-pay rule change could mean massive drug cost increases

How a quiet co-pay rule change could mean massive drug cost increases
October 22, 2020

BY TERRY WILCOX AND STACEY WORTHY The COVID-19 pandemic has hit those with chronic diseases especially hard. According to its most recent weekly summary, the Centers for Disease Control and Prevention estimates that 91% of patients hospitalized with the disease have at least one underlying medical condition. Patients with chronic diseases face an additional burden due to a…

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Americans Believe Government Should Require Copay Assistance Be Applied to Out-of-pocket Costs

Americans Believe Government Should Require Copay Assistance Be Applied to Out-of-pocket Costs
October 22, 2020

  The National Hemophilia Foundation (NHF) today released results from a new national online survey of registered voters that illustrates the importance and impact of patient copay assistance programs on patient affordability against the backdrop of the COVID-19 pandemic. The NHF survey, National Registered Voter Sentiment on Patient Copay Assistance Programs, found that 86 percent of…

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Understanding United Healthcare’s Accumulator Policy

Understanding United Healthcare’s Accumulator Policy
October 22, 2020

The following post is from Julie Baak, the Practice Manager for the Arthritis Center in Saint Louis, Missouri and a fierce patient advocate. What is a Copay Accumulator? Copay accumulator programs target the most costly specialty drugs. These drugs often have copay assistance programs in place to help offset costs to patients. A copay assistance program is where…

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PBM Exclusion Lists: Useful For Leverage But Do They Benefit The Patient?

PBM Exclusion Lists: Useful For Leverage But Do They Benefit The Patient?
May 6, 2020

Joshua Cohen forbes.com In January, the two largest pharmacy benefit managers (PBMs) – Express Scripts and CVS Caremark – increased the numbers of drugs on their 2020 exclusion lists. These lists include drugs that a PBM doesn’t recommend covering. PBMs’ clients – the plan sponsors – can choose not to adopt a formulary with exclusions,…

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With Federal Nod, Consumers Could Lose The Boost They Get From Drug ‘Coupons’

With Federal Nod, Consumers Could Lose The Boost They Get From Drug ‘Coupons’
May 6, 2020

Michelle Andrews khn.org Patients who get financial help from drug companies to cover their copayments for prescription drugs could owe a bigger chunk of their costs under a proposed federal rule. The annual rule, which sets a wide range of standards regarding benefits and payments for most health plans for next year, would allow employers…

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Military-health drug problems getting worse, cancer clinics say

Military-health drug problems getting worse, cancer clinics say
March 19, 2020

Community oncology clinics say that the military health system’s exclusive relationship with a giant corporation increasingly is putting them at a disadvantage. And that disadvantage is putting the health of veterans and members of the active-duty military at risk, the clinics say. The Community Oncology Alliance again wrote to the U.S. Department of Defense last…

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