50-State Network

ADVOCACY ISSUESAll Issues Recently Updated In the spotlight IN THE NEWS

Non-Medical Switching

Patient access to treatment should be determined exclusively by clinical decisions, not economic decisions.

Non-Medical Switching

Patient access to treatment should be determined exclusively by clinical decisions, not economic decisions.
Is Your State Fighting Back Against Step Therapy?

Healthcare insurance coverage on medications keeps changing as the political climate changes. This page will keep you up to date on the most recent changes and the State’s that need immediate action from you as an advocate. If you see your State listed or have experienced a step therapy issue follow the links below for help.
PBM Transparency

The Invisible Middlemen.

Pharmacy Benefit Managers

Pharmacy benefit managers (PBMs) are companies hired by insurers to manage drug benefit programs. They essentially act as middlemen between insurers, manufacturers, and pharmacies and thus have a uniquely central role in the drug market, handling everything from setting patient copayment amounts to determining which drugs are covered by which health plans. However, while they claim to reduce costs, the lack of transparency in their methods makes this claim difficult to prove.
Migraine

Categorized as a spectrum disease, ranging in frequency, severity and duration. Some people with migraine disease may experience as few as 1-2 attacks a year while others have 15 or more migraine days per month.

Migraine

There are new treatments on the horizon that are being specifically developed for migraine. We will keep you updated about: how/when they come to market and any obstacles to access that may arise.
Cardiovascular Access Issues

A new class of drugs for patients in need of cholesterol lowering treatments.

Cardiovascular Disease

PCSK9 inhibitors are a new class of drugs that hold promise for patients who have not responded to traditionally used cholesterol lowering drugs. Unfortunately, access to PCSK9 inhibitors has been challenging, with some reports stating that only one third of patients actually get the drug after they have received a prescription for its use.
Specialty Tier Drugs

Insurers and PBMs are restricting access and making patients shoulder more costs with discriminatory plan design

Non-Preferred and Specialty Tier Drugs

Help support bills that limit patients’ costs for specialty tier drugs. 87% of stand-alone Medicare Part D Prescription Drug Plans and 98% of Medicare Advantage-Prescription Drug Plans use specialty tiers, and this can be very expensive for those in need of special medicines.
Prior Authorization

Delaying access to required treatments.

Prior Authorization

Prior authorization is a system insurance companies use to contain health care spending. Insurance companies apply prior authorization procedures to certain high cost medications.
Fail First / Step Therapy

When a patient has to fail first on a drug before being allowed to take the medication originally prescribed, the patient, physician and public health suffers.

Fail First / Step Therapy

Fail First policies — also known as Step Therapy — are often insurance practices which require the least expensive drug in any class to be prescribed to a patient first, even if a patient’s physician believes a different therapy is medically in the best interest for their condition. Sometimes the cheapest drug works and sometimes it doesn’t. Your physician should make this decision, not your health insurance company
Biosimilars

A new class of treatments that can help lower healthcare costs.

Biosimilars

With expanding demand for good-quality healthcare, comes the challenge of controlling healthcare costs. The safe and regulated introduction of biosimilars into the market has been forecast to increase and improve access to much needed biologic medicines and reduce costs.

IN THE NEWSVIEW ALL

Amgen Just Slashed Its Price of the Cholesterol-Lowering Drug Repatha. So What Does This Mean for You?

Oct 29/

You may have heard that Amgen, which manufactures the cholesterol-lowering drug evolocumab (Repatha), just announced it is lowering the list price of the drug by about 60 percent to $5,850 per year fr

New York Proclaims June as Migraine and Headache Awareness Month

Jun 05/

On June 5, 2018 the New York State Assembly and Senate adopted a resolution proclaiming June as Migraine and Headache Awareness Month.

New Migraine Drug Approved. But Will Our Insurance Cover it?

May 18/

On May 17, 2018 the US Food a

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ADVOCACY ISSUESAll Issues Recently Updated In the spotlight IN THE NEWS

Non-Medical Switching

Pharmacy Benefit Managers

Migraine

Cardiovascular Disease

Non-Preferred and Specialty Tier Drugs

Prior Authorization

Fail First / Step Therapy

Biosimilars

IN THE NEWSVIEW ALL

Amgen Just Slashed Its Price of the Cholesterol-Lowering Drug Repatha. So What Does This Mean for You?

New York Proclaims June as Migraine and Headache Awareness Month

New Migraine Drug Approved. But Will Our Insurance Cover it?