The Massachusetts Health & Hospital Association (MHA), on behalf of our member hospitals, health systems, physician organizations and allied health care providers, appreciates the opportunity to submit comments regarding legislation that affects the relationships between pharmaceuticals and health insurers.
MHA supports HB792/SB513, “An Act Relative to Ensuring Transparency of Health Plan Formularies”. By requiring health insurers to post their drug formularies in an easily accessible and searchable manner, use a standard template to display formulary information and make comparisons among plans easier, include clear information about how deductibles will be applied, and detail applicable quantity limits, step therapy, or prior authorization requirements, HB792/SB513 will reduce confusion and provide consumers with greater transparency around their prescription drug benefits.
In particular, MHA supports the intended purpose of SB523, which appears to require coverage for the dispensing of specialty drugs under the pharmaceutical drug benefit by non-network pharmacies that provide special handling, administration and monitoring for such drugs. Recent changes to certain health insurer benefit structures require some patients to obtain non-self-administered, injected or infused specialty medications through a specialty pharmacy. In many cases, these medications are no longer covered by insurance companies unless patients: self-administer the medication; use a visiting nurse; or bring the drug to their physician’s office or hospital to be administered by a clinician – a practice known as “brown-bagging”. Hospitals believe that there are significant patient safety concerns associated with this practice as it relates to a subset of drugs used for supportive care of oncology and other chronic disease patients. The integrity of the affected prescription drugs – which have specific handling, storage and temperature control requirements, and, in many cases, are compounded prior to administration—cannot be verified in cases where a patient procures the medication on his or her own and brings it to a hospital or clinic for administration. As a result, providers are unable to confirm that the medication has not been exposed to conditions that would render it ineffective or unsafe.
Thank you for the opportunity to offer comments on these important matters. If you have any questions or concerns or require further information, please contact Michael Sroczynski, MHA’s Vice President of Government Advocacy, at (781) 262-6055 or msroczynski@mhalink.org.