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Bill Targets Insurers Changing Drug Coverage

Feb 23, 2017

No law in Florida prevents health insurance companies from changing the cost of a patient's prescription drugs -or from dropping coverage all together of that drug - in the middle of a 12-month contract.

But a bill filed in the Florida legislature forces insurers to stick by those contracts.

Last October, just before her next delivery of mail order asthma medication, Tampa resident Helen Almack got a notice from her insurance company she wasn’t prepared for.

"All of a sudden I get a letter saying they're not going to cover my Dulera and it's not even the end of the year, it's, you know, October, November. So now I am in a position where I need to call my doctor and say, 'Can we substitute? Do we need to fight this? How do I go about making sure I have a regular medicine?'" Almack said.

She’s locked in until her next enrollment period, but her insurer, UnitedHealthcare, is not. 

Michael Ruppal, executive director of the Tampa-based Aids Institute is part of Floridians for Reliable Health Coverage, a coalition of consumer and provider groups that back the nicknamed “Bait and Switch”  bill from Sen. Debbie Mayfield and Rep. Ralph Massullo.

"It really is a patient protection bill,” Ruppal said. “Although the insurance companies feel like this is am mandate, it is not. It is not an anti-insurance bill. It really is having the insurance companies honor the contract that they sign with the patients, negotiate with the patients, so that medications covered on day one are also covered on the last day of the contract."

When Almack doesn't have her medication, she can't climb a flight of stairs or take a walk without gasping for breath. But what used to cost her $125 for 90 days could double or triple without insurance coverage.

She's also worried about the possible side effects of a new medication.

"I know in other medications what they say is comparable isn't necessarily,” Almack said.

Almack sad when she called UnitedHealthcare they weren't able to tell her why her Dulera is no longer covered. UnitedHealthcare did not answer requests for an interview, but they did tell Almack the changes make medications more affordable for patients.

But she wishes the insurance company would let her doctor make decisions about what medications she should be on.

"I would think he would give me exactly what I need,’ Almack said.

Senate Bill co-sponsor Debbie Mayfield said the companies have a "one-sided view" when it comes to drug costs.

"They’re saying that it's a way of them keeping the cost overall costs down if they can switch drugs out if there's another drug that comes out that does the same thing and they're getting it at a lesser amount,” Mayfield said.

Mayfield said these lower costs don't take into account a patient having to pay for additional doctor visits for new prescriptions, and emergency expenses if an adverse reaction lands a patient in the hospital.

"Even though it may seem to be the identical medication there are differences between the drugs,” Mayfield said. “So you know the doctors should be the ones that make those determinations."

If passed, the bill would still allow insurance companies some leeway. They could add new medications and generics, or make coverage changes if the Food and Drug Administration announces safety concerns.

The bill doesn't not require the same of Medicaid, and similar provisions are already in place for Medicare. Mayfield says if Senate bill 182 passes and is signed into law, it could be used later as a model and applied to Medicaid. 

Until this issue is settled in Tallahassee, all Helen Almack can do is file an appeal to the insurance company - and use less of her medication to avoid running out.

“Usually when that sort of thing happens your doctor and you are filling out forms and faxing them to the insurance company for review,” Almack said. “There’s a bit of back and forth. I've seen it take almost two months to get that approved and I'll be out by then."

Sen. Mayfield said that aside from not taking into consideration what's best for the patient, bait and switch just isn't good business.

"There's not there's not another contract that I know of that you sign onto where people have the ability to change that contract during a 12-month period - or any period,”Mayfield said.

Maybe that's why Florida is one of three states considering similar legislation this year. Tennessee is moving along a similar bill and Massachusetts has created a commission to delve into the issue.

In the last couple years, Californian and Nevada have passed similar rules.

So far in Florida, the bill has passed several milestones, including support from the Senate Health Policy committee. A companion bill is also making its way through the house.