On this episode of the podcast, Terry and Bob discuss Congress’ consideration of the Build Back Better bill and the provisions that impact patients with rare and chronic diseases. They break down the legislative process ahead and highlight how the Senate parliamentarian will ultimately decide whether these provisions make it into the final bill. Specifically, they highlight three key healthcare provisions at risk in the Senate: price caps, transparency rules for pharmacy benefit managers, and the $35 monthly insulin price cap.
Terry previews a Patients Rising virtual panel next Wednesday on the future of biosimilars. Find out more about the event “Towards a Biosimilar Future: Safety, Savings, Solutions” and register HERE.
Legal expert Monica Bryant of Triage Cancer delivers her tips for open enrollment season. She discusses the different health insurance jargon and how these terms affect patients. She advises patients to choose health plans by multiplying monthly premium costs by their out-of-pocket maximum to determine their potential costs. She notes how it’s also important to examine health networks and make sure they use in-network providers. She warns patients to be careful of cut-rate insurance programs that don’t follow Obamacare regulations and can exclude categories of care such as chemotherapy. Asking for prior authorizations are also vital to protecting consumers. Finally, she advises patients to appeal insurance company denials because roughly half of appeals get decided in patients’ favor.
A patient advocate concludes the episode by explaining how Social Security asset limits keep her disabled daughter in poverty. Her independence depends on these social services, but these services don’t allow her to acquire more than $2,000 in assets. The SSI Restoration Act would allow vulnerable patients like her daughter to become financially independent without losing coverage.