Welcome to the April edition of Terry’s Hot Take, a monthly resource for lawmakers by the Executive Director of Patients Rising, which advocates on behalf of the 133 million Americans living with chronic disease.

Patients Rising Now Statement on CMS Coverage Determination for Alzheimer’s Patients Rising Now will continue to work to give patients a voice through the implementation of national coverage determinations and protect the integrity of accelerated approval for future therapies. In response to CMS’ final decision to restrict access to FDA-approved Alzheimer’s treatments to clinical trial participants here. 

Patients Rising Honors 2022 Health Plan Heroes

Six businesses from across the country were honored recipients of the 2022 Health Plan Hero award, which recognizes companies that offer high-value, low-cost health insurance plans for employees. They include John Soules Foods (Tyler, TX), Kenny Pipe and Supply (Nashville, TN), Matheny Motors (Parkersburg, WV), Schaefer Autobody (St. Louis, MO), Shine Solar (Rogers, AK), and Woodard Cleaning and Restoration (St. Louis, MO). 

These health plans have made care affordable for employees, while also saving on the business’s bottom line. Read up on how these companies are slashing costs while bolstering coverage for employees.

The Verifying Accurate Leading-edge IVCT Development (VALID) Act

User fee agreements for a medical device or a prescription drug create a path for manufacturers to get their product reviewed in a systematic manner by the FDA. The Medical Device User Fee and Modernization Act of 2002 (MDUFA) grants new responsibilities and resources to the FDA and speeds up the approval process. Patients Rising Now supports MDUFA reauthorization. The VALID Act will update the review process for diagnostic products and also clarify the distinct roles that the FDA and CMS will play in regulating the products and the laboratories that develop these products. 

Supporting the Ban on Copay Accumulators

Patients are taking action at the state level to support a ban on copay accumulators. Copay accumulators are an insurance benefit design adopted by an increasing number of insurance plans. These programs prevent patients from using third party contributions toward a patient’s  out-of-pocket expenses under cost-sharing requirements . Several states (AR, AZ, CT, GA, IL, KY, LA, NC, OK, TN, VA, WV and PR) have already put an end to this discriminatory practice by passing legislation that bans accumulator policies. Check out our coalition letter in NY.

The Latest on the Patients Rising Podcast: On our most recent episode, $1 Prescriptions: The Future of Health Insurance, we hear from small businesses who have reshaped their health plans to save on their bottom line and offer high-quality low-cost care to their employees. From $0 deductibles to no cost-sharing, the private sector is leading the charge for affordable care through innovative benefit design. 

Other recent weekly episodes:

Hear from Tennessee resident Elisa Colmer, who lives with rheumatoid arthritis, Sjogren’s, and myasthenia gravis, and has been impacted by pharmacy benefit manager “gotchas.” (34:19). She explains what she calls “insurance injury,” which happens when insurance and PBM practices get in the way of her care. 

You can listen to these episodes and subscribe to Patients Rising Podcast via your favorite podcast app, like Apple PodcastSpotifyGoogle Podcast 

Patients Rising Podcast is published every Friday with the purpose to update patients on issues in Washington that affect them. Each week patients are interviewed on policy challenges that come with treating their disease, along with new information on the latest health issues and legal help for patients.

Every month we hope to lend a patient lens to legislation and regulation. If Patients Rising can be of assistance to your office, please reach out to me directly via twilcox@patientsrising.org or at 202-750-4331.

Take care,