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40 Georgia Patient & Physician Groups Urge Governor Kemp to Sign PBM Reform

Atlanta, GA (July 20, 2020) – Forty Georgia patient and physician groups, led by the Rx in Reach GA Coalition, today urged Governor Brian Kemp to sign Senate Bill 313 and House Bills 946, 918, and 991 which work together to tighten regulations of pharmacy benefit managers (PBMs) and increase patient access to medications. PBMs are little-known middlemen who profit in the health care system by negotiating between health insurers, drug manufacturers and pharmacies, often resulting in confusing policies and higher prices for patients. 

Due to the efforts of Sen. Dean Burke, and Reps. David Knight, Sharon Cooper and Matt Hatchett, these bills passed the Georgia General Assembly with strong bipartisan and bicameral support. The bills will lead to improved patient access to prescription medications and financial relief for patients. The legislation requires that PBMs pass on savings from their negotiations to health care plans, and also requires that any copay assistance that patients receive for generic medications is applied towards the patient’s cost-sharing or copay responsibilities.  

Click below to read the full letter.

40 Georgia Patient & Physician Groups Applaud Passing
Legislation to Tighten Regulation of Pharmacy Benefit Managers

Atlanta, GA (June 25, 2020) – Forty Georgia patient and physician groups, led by the Rx in Reach GA Coalition, today applauded the Georgia General Assembly for passing Senate Bill 313 and House Bills 946, 918, and 991 which work together to tighten regulations of pharmacy benefit managers (PBMs) and increase patient access to medications. PBMs are little-known middlemen who profit in the health care system by negotiating between health insurers, drug manufacturers and pharmacies, often resulting in confusing policies and higher prices for patients. 

“Thanks to the efforts of Sen. Dean Burke,  and Reps. David Knight, Sharon Cooper, and Matt Hatchett, Georgia patients will now have more choice in where to get their prescriptions and at a lower cost,” said Dorothy Leone-Glasser, RN, HHC, the Executive Director of Advocates for Responsible Care, which leads the Rx in Reach GA Coalition. “PBMs have complicated the prescription drug market for too long, and this legislation is an important step towards helping patients access the prescription drugs and treatments they need. We look forward to Governor Brian Kemp signing these bills into law.” 

Click below to continue reading the full press release. 

Georgia House tightens regulations on prescription drug pricing

The Citizens

 

ATLANTA - Third-party companies that help set prescription drug prices would face tighter regulations under identical bills the Georgia House of Representatives and state Senate passed unanimously Monday.

Pharmacy benefits managers (PBMs) negotiate between insurance companies and pharmacies to set drug prices.

But too often, PBMs hide behind unscrupulous practices that allow them to increase prices without sufficient oversight, said Rep. David Knight, R-Griffin.

Senate Bill 313, which cleared the state Senate in March, follows legislation the General Assembly passed last year to prevent PMS from steering patients to associated pharmacies with potentially higher costs.

The House amended this year’s bill as it went through the committee process to make it identical to House Bill 946, PBM legislation the House passed, also in March.

 

Click below to continue reading the full article. 
 

Pharmacy steering detrimental to patient care

The Newnan Times-Herald

 

I purchased Lee King Pharmacy because I wanted to provide world-class care for people in my community with a personal touch.


Since purchasing the pharmacy in January of this year, I have had the privilege of providing care under the most trying health care crisis this country has seen in our lifetime.

 

In doing so, I have seen the best this country has to offer from physicians, nurses, pharmacists and pharmacy technicians. I have also seen it from our patients and their relatives and loved ones, who are willing to go the extra mile to stay healthy and safe.


But I have also seen a darker side to America’s health care system – PATIENT STEERING. During this COVID-19 pandemic, I’ve had more than 15 patients who were steered from my pharmacy to pharmacies owned or affiliated with the patient’s insurance company or their pharmacy benefits manager.


To be clear, these are patients, who are often very sick with chronic diseases including cancer, who chose my pharmacy, who traveled to my pharmacy, who needed drugs, and who were told, at the height of the pandemic, that they had to receive their drugs from a mail order pharmacy (delaying treatment up to three weeks) or retail chain pharmacy affiliated with the insurer or PBM.

 

Click below to continue reading the full article. 
 

Letter to the Editor: Legislation would give Georgians with greater choice in healthcare

John's Creek Herald // NorthFulton.com 

 

As our state continues to combat the effects of the coronavirus, the ability to access high-quality health care is an issue at the forefront of the minds of many Georgians. Independent pharmacists have long played a critical role in providing personalized care to our communities, but because of roadblocks faced by some community pharmacists, too many of Georgia’s patients are now being forced to wait for critical medications. To ensure Georgians can access the care they need, lawmakers must act to protect the important role of community pharmacies, which are more critical than ever amid the coronavirus.

As a clinical pharmacist and the owner of Lily’s Pharmacy in Johns Creek, I know first-hand the important role independent community pharmacists play in delivering high-quality, personal care to our patients. But as pharmacy benefit managers (PBMs), little-known middlemen in the health care system, have gained outsized power and influence, it has become increasingly difficult for community pharmacists to deliver care in a timely manner.

PBMs manage drug benefits for 95 percent of Americans with prescription drug coverage, and most PBMs also own a mail order pharmacy. PBMs, therefore, have the power to financially penalize nearly every patient that chooses to use their community pharmacy instead of the PBM mail order pharmacy. This abuse at the pharmacist care-level by PBM mandates has led to the closing of many locally owned pharmacies. And a lack of patient choice and personal care is having very real consequences, with many pharmacists across Georgia are being prevented from filling patients’ medications because of PBM mandates.

Fortunately, the Georgia General Assembly is considering Senate Bill 313 and House Bill 946, which propose new regulations to provide oversight to PBMs. When the Georgia General Assembly resumes session in June, lawmakers must act to swiftly pass this important legislation and ensure Georgians can receive timely care, including treatments for COVID-19.

For too long, PBMs have operated unchecked, prioritizing their bottom lines over the health and wellbeing of Georgians. Now, lawmakers in Atlanta have the opportunity to enact legislation that will both ensure patients can access the medications they need, when they need them, and protect the important role of community pharmacists

Atlanta Business Chronicle Names Dorothy Leone-Glasser as a 2020 Health Care Hero

The Atlanta Business Chronicle

 

by H.M. Cauley

 

It is no question that the health-care industry is full of people who, day after day, pandemic or no, work tirelessly to heal their patients. In this current climate, the world is paying even more attention to these doctors, nurses, allied health professionals, physical therapists and others who many consider heroes.

Nominated by their peers and colleagues and chosen by members of Atlanta Business Chronicle’s editorial staff, these health-care professionals are our Health Care Heroes for 2020. 

COMMUNITY OUTREACH

Winner: Dorothy Leone-Glasser, Advocates for Responsible Care (ARxC)  

Click below for the full article. 

Dorothy wishes to thank the The Pfizer Foundation for their generosity to continue the great work of ARxC. 

Georgia bill seeks lower drug prices by focusing on middlemen

The Atlanta Journal-Constitution

 

by Ariel Hart

 

In an effort to attack high drug prices, Georgia lawmakers are focusing on powerful middlemen who negotiate on behalf of insurance companies.

State Sen. Dean Burke, R-Bainbridge, has introduced a bill that aims to shed light on prices that pharmacy benefits managers negotiate with pharmaceutical companies and pharmacies, and to ensure that patients are able to get the drugs when they need them. The legislation is Senate Bill 313.

Your Support Needed: SB 313 Has Critical Hearing on February 12, 2020

Support SB 313, An Act to Provide Oversight and Regulation of PBMs

 

We need to fill the room on Wednesday, February 12, 2020, to get SB 313 on PBM oversight passed! SB 313 is being heard in the Senate Insurance & Labor Subcommittee on Wednesday, February 12, 2020 at 1:00 pm in Room 310 of the Coverdell Legislative Office Building. 

If you have a PBM story or if your physician can come to speak, please contact Dorothy Leone-Glasser, RN, HHC immediate: email dlg@arxc.org or call 404-633-5843.

We need the Senate subcommittee to see patient advocates who care that PBMs are blocking their access to prescription drugs and treatments.

This cannot happen without you!

 

Click here to read the legislation.

 

Coverdell Legislative Office Building

18 Capitol Square SW

Atlanta, GA 30334

Georgia Health News

 

by Andy Miller

 

Pharmacy benefit managers (PBMs) are major contributors both to ballooning prescription drug prices and the lack of transparency around it.

 

Yet, if you’re like many Americans, there’s a good chance you’ve never heard of them.

 

Although they are not physicians, drug makers, insurers, or pharmacists, these companies play an outsized role in our healthcare system, making medical decisions including which prescription drugs you may take – and also how much you’ll pay for them.

The Middlemen Getting Rich Off Your Prescriptions

Even when drug companies cut prices by over half, patients pay too much

 

by Dorothy Leone-Glasser, RN, HHC.

 

Pharmacy benefit managers (PBMs) are major contributors both to ballooning prescription drug prices and the lack of transparency around it.

 

Yet, if you’re like many Americans, there’s a good chance you’ve never heard of them.

 

Although they are not physicians, drug makers, insurers, or pharmacists, these companies play an outsized role in our healthcare system, making medical decisions including which prescription drugs you may take – and also how much you’ll pay for them.

Georgia Legislature’s impact on health care this year was ‘pretty big’

ATLANTA JOURNAL-CONSTITUTION

Insurance companies are increasingly using their power to push back against rising health care costs. And the doctors and hospitals who bill those costs increasingly say they’re going too far, meddling in medical decision making.

“Step therapy” is one such instance, where an insurance company says a patient can’t have a medicine his or her doctor prescribed right away, at least not paid for by insurance. First, the company says, the patient must try a cheaper alternative. If that doesn’t work, then the patient might step up to the one prescribed by the doctor.

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A bill passed in the state Legislature this year attempts to compromise. House Bill 63 says patients can avoid step therapy with a “step therapy exception” in certain cases. Those include whether the drug “is expected to be ineffective” based on the patient’s condition and the drug’s characteristics, or if it will cause physical or mental harm to the patient.

Gov. Kemp signs bill to limit ‘Fail First' insurer decisions for chronic conditions

FOX 5 ATLANTA

Gov. Brian Kemp moved to limit a health insurance process known as "Step Therapy" when treating chronic conditions on Thursday.

The process, also known as "Fail First," forces patients to try older, often less expensive medications to prove those medications won't work.

Atlanta Journal Constitution:
Fixing ‘Step Therapy’ can help solve pain crisis

BY REP. KIM SCHOFIELD

Chronic pain and how to treat it in the midst of the opioid epidemic has been a topic of national importance for quite some time now – and rightly so. But missing from the national debate has been the role insurance companies can, and should, play in covering non-opioid treatments for pain.

To save money, health plans often require people to “fail first” by trying and failing on therapies other than what their physicians have prescribed. This process, called step therapy, can mean weeks, months or even years without appropriate treatment. Meanwhile, people like me continue to suffer the symptoms of chronic disease and even unwanted side effects of the insurer-preferred medications.

GA lawmakers consider bill giving doctors more say in prescriptions over insurers

ATLANTA (WJBF) - The concept is basic, what you expect when you go to the doctor. Your doctor prescribes the medication that will help you get better, right?

In Georgia...wrong.

Georgia law doesn't ban step therapy, which allows insurers to make you try older, cheaper drugs before the new ones your doctor prescribes.

"What they wanted our epileptic patients to do was to fail twice on two different kinds of medication before they would give them the medication that would keep their seizures in order. If you fail, and you're an epileptic and have seizure, you lose your drivers license for 6 months. How does a father or mother support their family or get to school? It's so ridiculous," says Rep. Sharon Cooper.

Georgia House Passes Legislation to Reform Step Therapy Insurance Practice Requiring Patients to 'Fail First'

Atlanta, GA (Feb. 15, 2019) – More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded the state House of Representatives for passing House Bill 63 – legislation sponsored by Rep. Sharon Cooper (R-Marietta) to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes. In some cases, insurers even require step therapy when patients have already tried the insurer-preferred medications, or when those medications could cause their health to deteriorate. 

Georgia House Passes Legislation to Reform Step Therapy Insurance Practice Requiring Patients to 'Fail First'

Atlanta, GA (Feb. 15, 2019) – More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded the state House of Representatives for passing House Bill 63 – legislation sponsored by Rep. Sharon Cooper (R-Marietta) to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes. In some cases, insurers even require step therapy when patients have already tried the insurer-preferred medications, or when those medications could cause their health to deteriorate. 

House panel backs curbs on ‘step therapy’ rules for medications

When Brannen Whirledge was diagnosed with ulcerative colitis at age 4, he was put on medications that failed to help him. He suffered continual vomiting and severe stomach cramps.

 

Then they found a medication that worked. Brannen’s symptoms went away.

 

But after six months, says his mother, Melissa Whirledge, the family’s insurer told them that it would no longer cover the effective medication until “he failed on other drugs that he had already failed on.’’

 

The family appealed that ruling, and Brannen, now 7, has received exceptions to the drug restrictions. He is doing well, his mother says.

Georgia House Insurance Committee Unanimously Passes Legislation to Reform Step Therapy Insurance Practice

Atlanta, GA (February 13, 2019) - More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded the state House Insurance Committee and its chair, Rep. Richard Smith (R-Columbus), for unanimously passing House Bill 63 -- legislation sponsored by Rep. Sharon Cooper (R-Marietta) to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes.

Georgia woman battles HMO's switch from insulin pens to syringes

SUWANEE, Ga. (FOX 5 Atlanta) - Carol Bolton, a Suwanee, Georgia mother of two, says her insulin KwikPen has helped her stay on top of her type 2 diabetes for more than a decade.

 

"There is nothing to it; it's so easy and quick," Bolton says. "You just take it out of your purse, adjust the insulin level and inject the insulin into your stomach."

 

But in early December, she says, she got a letter from her HMO, Kaiser Permanente of Georgia, telling Bolton she would have to switch from the insulin KwikPen back to the traditional vials and syringes.

More than 30 Patient & Physician Groups Applaud Georgia Legislation to Reform Step Therapy Insurance Practice 

Atlanta, GA (Jan. 28, 2019) – More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded Rep. Sharon Cooper (R-Marietta) for introducing House Bill 63 – legislation to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes – and in some cases, happens even when patients have already tried the insurer-preferred medications or when those medications could cause their health to deteriorate. 

1 in 4 doctors say prior authorization has led to a serious adverse event

It just keeps getting worse. That’s a major finding of an AMA survey of 1,000 practicing physicians who were asked about the impact prior authorization (PA) is having on their ability to help their patients.

 

More than nine in 10 respondents said PA had a significant or somewhat negative clinical impact, with 28 percent reporting that prior authorization had led to a serious adverse event such as a death, hospitalization, disability or permanent bodily damage, or other life-threatening event for a patient in their care.

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Dorothy Leone-Glasser, RN, HHC
Executive Director,

Advocates for Responsible Care

Email: dlg@arxc.org
Phone: 404-633-5843

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