Since declaring a statewide coronavirus emergency on March 11, Louisiana has taken decisive action to help patients through the public health crisis.
Insurance Commissioner Jim Donelon has issued a set of sweeping emergency orders that expand patients’ access to treatments, speed up COVID-19 testing, and remove insurance barriers that force patients to overcrowd hospitals and clinics.
“This effort will ensure Louisiana policyholders will have seamless access to testing, pharmaceuticals and care throughout Louisiana,” Commissioner Donelon explained in a press release.
Patient advocates have praised Commissioner Donelon’s emergency orders as a model of pro-patient emergency rules that eliminate unnecessary costs, reduce doctor’s visits and cut through red tape.
“Louisiana showed tremendous leadership by adopting emergency rules that ensure patient access to care during this public health crisis,” said Terry Wilcox, executive director of Patients Rising, a national patient advocacy non-profit organization that helps patients overcome access barriers. “Every state should take similar steps to eliminate barriers to access during this public health crisis.”
Louisiana Association of Health Plans Lawsuit to Bring Back Barriers
But not everyone down in the Bayou is pleased with the emergency efforts to eliminate barriers to access. Last week, the Louisiana Association of Health Plans announced plans to file a lawsuit to overturn the emergency rules and reinstate the insurance barriers imposed on patients.
The state insurance industry lobbying association, which represents Blue Cross and Blue Shield of Louisiana, Peoples Health, MultiPlan, Cigna, EqHealth Solutions, Healthy Blue, United, Vantage Health, Humana and Wellcare Health Plans, says that insurance companies would be “immediately and significantly harmed” by the new rules.
“While doctors and nurses are putting their lives on the line to help patients, insurance companies in Louisiana are suing to boost their profits,” says Wilcox of Patients Rising.
The decision to sue during the public health crisis was considered too extreme for some members. Aetna, Humana and WellCare have publicly opposed the lawsuit in statements, according to the Advocate.
“Our top priority is to ensure the health of our members and the communities in which they live and work, and we believe in working collaboratively with the state during these unprecedented times,” the company said in a statement. “The controversial decision by LAHP to pursue this litigation does not align with our mission or values.”
Louisiana: Model Example of Pro-Patient Emergency Insurance Rules
If Louisiana is successful in overcoming the insurance industry’s lawsuit, it could offer a national model for other states. Under Emergency Rule 36, insurance companies in Louisiana must waive cost sharing for COVID-19 testing, allow patients to receive early refills of medications and are prohibited from using step therapy protocols that force patients to fail first on the wrong treatment.
Insurance companies and pharmacy benefit managers use step therapy policies to deny patients access to the treatment prescribed by their doctor. Instead, patients must fail first on a cheaper and less effective treatment selected by the insurance company. In addition to jeopardizing a patient’s health, step therapy adds more trips to the doctor’s office to complete insurance paperwork.
“Right now, we’re trying to reduce the number of patient visits to clinics, hospitals and emergency departments,” points out Wilcox of Patients Rising.
“Not only does prudent use of telemedicine services promote social distancing, these services also provide a powerful tool to maintain access to critical care during this event,” Commissioner Donelon said.
COVID-19 Crisis: Emergency Insurance Orders
Under Louisiana’s Emergency Insurance Rules, insurers must:
- Waive cost sharing for COVID-19 testing when ordered in accordance with CDC guidelines and are prohibited from requiring prior authorization for this testing.
- Permit early refills, except for drugs in certain drug classes like opioids, when consistent with doctor/pharmacist approvals.
- Prohibit the use of step therapy.
- Enhance access to mail order pharmaceuticals.
- Continue to ensure network adequacy given the anticipated increase in demand due to COVID-19.
- Suspends cancellation, non-renewal and non-reinstatement by insurers, or premium finance companies acting on behalf of insurers retroactively to the start of this emergency period. Additionally, this rule clarifies that no policy can be canceled or non-renewed because of a claim that is filed during this emergency.
- Maintain the same cost-sharing amount in the step-down facility that they would have paid had they remained in the acute care hospital.