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Patients/Consumers/Doctors Urge Governor to Sign Bill Stopping Mid-Year Rx Out-of-Pocket Cost Hikes

Prescription pills with money
Photo Credit: iStock/UrosPoteko
Photo Credit: iStock/UrosPoteko

36 Patient/Consumer/Doctor Organizations Urge Governor to Sign Bill Stopping Mid-Year Rx Out-of-Pocket Cost Hikes

Cancer, Diabetes, Heart, Liver, Lung, Physician Groups Join AARP in Calling to Protect Health Plan Enrollees From Mid-Contract Increases

ALBANY, N.Y. – A broad range of organizations representing patients, consumers and doctors is urging Governor Andrew Cuomo to approve a bill that would protect health plan members from increases in out-of-pocket prescription drug costs in the middle of a contract year.

The 36 groups sent a letter to the Governor calling on him to sign into law S2849A/A2969A.

The bill, which passed the state legislature with bipartisan support, prohibits health care plans from making changes to prescription drug formularies during a contract year and requires notification of changes in to formularies in the upcoming contract year.

“Patients may need to choose between paying more out of pocket and switching to a different, and possibly less effective, drug,” the letter says. Such switches “can have adverse health outcomes, including less effective treatment and negative side effects.”

Many consumers choose their health plan based on prescription drug coverage and costs, particularly patients with multiple chronic conditions. But while consumers are locked into their plan for the contract year, the insurance company isn’t; it can switch drugs into a different “tier” with a higher co-pay, coinsurance or deductible – resulting in a higher out-of-pocket cost to the consumer.

The bill sponsored by Senate Insurance Committee Chair Neil Breslin and Assembly Majority Leader Crystal Peoples-Stokes, which passed the state legislature earlier this year, would ensure that patients can stick to their budget and their care plans while still allowing for innovations in the prescription drug market.

The legislation permits new medications, generics and biosimilars to be added to drug formularies. That would allow patients to switch to new medications in consultation with their doctors - and allow lower cost generic drugs to replace brand name drugs when they enter the market.

“We are confident that this bill will not increase consumer costs,” the letter says. California, Illinois, Louisiana, Maine and Nevada put similar laws on the books without increases in health care costs.


AARP New York
Aimed Alliance
Alliance for Patient Access
American Cancer Society Cancer Action Network
American College of Rheumatology
American Diabetes Association
American Heart Association
American Liver Foundation
American Lung Association
Arthritis Foundation
Asthma and Allergy Network
Center for Independence of the Disabled, NY
Cerebral Palsy Associations of NYS
Coalition of State Rheumatology Organizations
Epilepsy Foundation of Northeastern New York, Inc.
Global Healthy Living Foundation
Hispanic Health Network
Lupus and Allied Diseases Association, Inc.
Latino Commission on AIDS Hispanic Health Network
Medical Society of the State of New York
Mental Health Association in New York State, Inc. (MHANYS)
NAACP New York State Conference
National Infusion Center Association (NICA)
National Multiple Sclerosis Society
National Patient Advocate Foundation
National Psoriasis Foundation
New York American College of Physicians
New Yorkers for Accessible Health Coverage
New York State Academy of Family Physicians
New York State Osteopathic Medical Society
New York State Rheumatology Society
Northeast Kidney Foundation
Patients Rising Now
Susan G. Komen
The National Alliance on Mental Illness-New York State (NAMI-NYS)
US Pain Foundation


Beth Finkel, AARP New York State Director: “Consumers count on the drugs they need at the price they expect when they enroll or re-enroll in a health plan. It’s simply unfair for insurers to change the rules – and the costs – in the middle of the game. Similar laws in other states have successfully protected consumers. AARP thanks Senator Breslin and Assembly Majority Leader Peoples-Stokes for pushing this bill through their houses and we urge Governor Cuomo to protect New York’s consumers by signing it into law.”

Dr. Arthur Fougner, President, Medical Society of the State of New York: “MSSNY strongly urges that this formulary protection bill be signed into law as it would provide significant protection from the adverse consequences many patients face as a result of non-medical switching of prescription drugs. If a treatment is working, it should not be changed due to financial constraints. In medicine as in sports, you don’t change a winning game; it’s unreasonable to force patients to change a successful course of treatment for any reason other than medical need.”

Guillermo Chacon, President of the Latino Commission on AIDS and founder of the Hispanic Health Network: “Health care and medication costs have an impact on health care consumers. Many patients are overwhelmed with their chronic health conditions and shouldn’t need to think about they have the possibility to pay for their next medical visit or medications. Many states have already moved forth on developing protections for consumers that have not impacted health care costs. Critical consumer protections will benefit New Yorkers who find challenges on accessing care and treatment.”

Jennifer Muthig, Director, Advocacy & Policy, National Multiple Sclerosis Society: “The bottom line is that when New Yorkers sign a contract with an insurance company, mid-year changes leave them with unfair and limited options. For those living with chronic diseases such as Multiple Sclerosis, their life changing disease modifying therapies are not interchangeable and unwarranted medication changes by insurance companies may lead to a greater number in overall healthcare costs due to more hospital and physician visits.”

Barbara Keber, MD, President of the NYS Academy of Family Physicians, representing over 6,000 members across the State: “Patients rely on their health plans to cover the medication that their particular condition(s) requires at a steady, predictable price point for the full term of their health insurance contract policy. Many seek out specific policies and formularies based on current or anticipated medication needs. Importantly, this legislation would help to create that stability for patients and we urge Governor Cuomo to sign it into law.”

Matthew Shapiro, Associate Director, Public Affairs, National Alliance on Mental Illness-NYS: “NAMI-NYS firmly believes in a person-centered approach to treating psychiatric disorders. Crucial to person centered care is receiving the medication a psychiatric provider determines to be most appropriate an individual’s recovery. Having a medication switched by an insurance company is a dangerous practice, especially for those with the most serious forms of mental illness including schizophrenia and bi-polar disorder. We urge Governor Cuomo to hear the cry of patient advocates and recognize the overwhelming support of the legislature and reform the deceitful practice of non-medical switching.”

Mary Bartlett, State Director, Advocacy & Access, Arthritis Foundation: “Patients with chronic conditions carefully choose health plans that best match the needs of their complex conditions. When a health insurer makes changes to the formulary in the middle of a plan year, it can mean delays in care or a patient stopping medication all together. Signing this bill is essential to protecting patients in New York State from this unfair insurance practice.”

Dr. Thomas Schumacher, Chairman of the Board, Northeast Kidney Foundation: “We urge Governor Cuomo to sign S.2849-A/A.2969-A prohibiting mid-year formulary changes into law. This bill protects patients from having to incur increased medical costs because of a formulary change. For patients taking multiple medications, like those with kidney disease and other chronic health conditions, higher co-pays can make it difficult for them to stay adherent to their treatment. We need to stabilize patients and decrease healthcare cost. This bill provides an important protection and on behalf of the patients we serve, we urge Governor Cuomo to sign the bill into law.”

Tonya A. Winders, President and CEO, Allergy & Asthma Network: “Allergy & Asthma Network implores Governor Cuomo to sign S2849-A/A2969-A in order to protect families from mid-year formulary changes. This is an important measure to ensure families have continuity of care, which lead to better health outcomes.”

Shaina Smith, Director of State Advocacy and Alliance Development for U.S. Pain Foundation: “New York children and adults with chronic diseases that cause pain deserve to remain on their medically appropriate and necessary treatment regimen, without interruption from health plans. Governor Cuomo's signing of this bill will keep families and individuals protected from harmful midyear medication switches while upholding the insurer's end of the health plan contract."

John Richter, MPA, Director of Public Policy, Mental Health Association in New York State Inc.: “Medication continuity is extremely important for people with mental illnesses who are already at risk of disruptions in their recovery for a variety of reasons. Sudden unexpected shifts in medication costs during an enrollment year, or medications being dropped from a formulary altogether, adds precariously to this risk and can be dangerously counter therapeutic.”

Jeannine Garab, Executive Director, Epilepsy Foundation of Northeastern New York, Chair, Epilepsy Coalition of New York State: “For the majority of people living with epilepsy, medications are the most common and cost-effective treatment for controlling and/or reducing seizures. Epilepsy medications are not interchangeable, and treatment of epilepsy is highly individualized - there is no "one size fits all" treatment option. Maintaining seizure control with minimal side effects requires careful evaluation and monitoring by physicians and their patients. To change, limit, or deny access to medications could be extremely dangerous, and lead to breakthrough seizures and related complications, including death. For these reasons, I urge Governor Cuomo to sign S.2849-A/A.2969-A into law.”

Howard Blumstein, MD, FACR, President of the New York State Rheumatology Society: “The New York State Rheumatology Society strongly encourages Governor Cuomo to complete the important work accomplished by our state legislature by signing S.2849-A/A.2969-A into law. This important legislation will protect the residents of New York State from capricious and purely financially driven decisions made by insurance companies which essentially violate members’ contracts and endanger critical access to medications needed to manage serious chronic medical conditions including inflammatory arthritis and autoimmune conditions.”

Sherman Dunn, DO, President of the New York State Osteopathic Medical Society: “NYSOMS believes that it is poor clinical care to force stabilized patients to switch medications during a contract period they entered in good faith. Mid-year formulary changes also negate the clinical judgment of the trained physician, which should always take precedence over payer cost considerations when deciding about individual care. For patients suffering from chronic conditions, non-medical switching can ultimately require more expensive medical interventions, such as hospitalization. S.2849-A/A.2969-A would ensure that insurance companies are bound to the same contract as consumers, and for those reasons, NYSOMS urges Governor Cuomo to sign this bill into law.”

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