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After a two-year effort put forth by the Illinois Fair Care Coalition, a group of patient and provider groups co-led by U.S. Pain Foundation and the Arthritis Foundation, children and adults living with chronic conditions will no longer face potentially harmful prescription coverage changes during the health plan year. Governor Bruce Rauner signed House Bill 4146 into law at the end of August, a bipartisan measure that will help protect families from an unfair insurance practice known as non-medical switching.

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Milestone events took place on April 3 and 11 as U.S. Pain Foundation hosted a legislative breakfast and two advocacy days, a first for the organization, which previously has hosted them only in collaboration with allied partners. The focus of both days was bills that enhance patient safety by limiting the practice of forced medication switches, known as nonmedical switching.

The April 3 program was held at the Connecticut State Capitol and featured keynote legislative speakers, a panel discussion with patients impacted by health coverage interruptions, and a summary of legislation proposed this session. Rep. Michelle Cook and Sen. Heather Somers, cosponsors of Senate Bill 379, addressed those in attendance at the breakfast, with Cook revealing her personal experience with nonmedical switching.

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U.S. Pain is part of a coalition of 41 patient and provider groups supporting the “Bait-and-Switch Bill,” SB 360/HB 229, which would require health plans to deliver on the prescription coverage benefits they market and sell for the year. Right now, at any time during the health plan year, insurers are free to increase out-of-pocket costs, enact restrictions on coverage (e.g. additional prior authorizations), or remove coverage of a prescription medication altogether – practices commonly referred to as “nonmedical switching.” These unfair changes can have negative health consequences, especially for patients with serious, chronic conditions.

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In a conference room overlooking Washington, D.C., nonprofit organizations and other stakeholders gathered around the table and gave U.S. Pain Foundation the opportunity to present ideas and cultivate conversations surrounding patient access issues.

Known as the Keeping Patients Stable on Their Medications Coalition, the group had met in the past to address step therapy and nonmedical switching, two common insurance barriers to medications. Now under the leadership of the U.S. Pain Foundation, the goal is to expand upon the coalition’s initial efforts.

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Did you know that insurers can reduce your prescription coverage at any time? On June 6, Shaina Smith, U.S. Pain director of state advocacy and alliance development, traveled to Pennsylvania to speak on a panel asked about improving patient stability by limiting midyear prescription coverage changes. Women in Government partnered with the Pennsylvanians for Fair Health Coverage Coalition, of which U.S. Pain belongs, to host the event.

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The U.S. Pain Foundation is pleased to announce its new campaign and related website, “Don’t Switch Me,” to fight back against insurers forcing medically stable patients off the prescription treatments that manage their chronic conditions.

Right now, in most states, insurers can force patients off of medications they’ve been stable on– even for years – at almost any time. The practice of forcing patients onto insurer-preferred drugs, instead of what clinicians prescribe, is commonly known as “nonmedical switching.” It is considered “nonmedical” switching because the switch is the result of financial reasons, not medical ones.

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Nonmedical switching advocacy had some major developments in April, as many state legislative sessions began to wrap up. Nonmedical switching occurs when insurers force patients off medications for financial reasons instead of medical ones. U.S. Pain is among many patient groups who oppose nonmedical switching; studies show it is bad for patients’ health and can be costlier in the long run. While U.S. Pain is involved in related efforts in multiple states, the below updates relate to those states where the organization is most actively involved.

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Lemiska after testifying at the CT state house about a nonmedical switching bill.

The pace of the 2017 legislative session picked up this month as U.S. Pain continues to lead related coalitions in three state—Tennessee, Illinois, and Connecticut—and sits on the steering committee of a coalition in Texas. Nonmedical switching occurs when insurers force patients off medications for financial reasons instead of medical ones; studies show it is bad for patients’ health and can be costlier in the long run.

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