Advocacy Successes
Physician Advocacy Successes
Good health policy is made with physicians in the discussion.
MSDC, working with its members, partners, and other organizations, has won major policy victories to help its members practice medicine. Below is a sampling of those victories. Do you want to be a vital part of the next policy victory helping improve the health of the District? Contact us today.
Opioid Policy
- MSDC was added to the opioid fund oversight panel by the Council in its legislation authorizing the oversight body
Scope of Practice
- MSDC supported legislation to ban the sale of flavored electronic smoking devices and restrict the sale of electronic smoking devices.
- Working with a coalition, MSDC added funding to the DC budget to support the hiring of more license specialists to help with the delay in processing medical licenses.
Women's Health
- B24-143, to regulate certified midwives, passed the Council with MSDC's support
Health Equity
- Mayor Muriel Bowser signs into law the Electronic Medical Order for Scope of Treatment Registry Amendment Act of 2019. The eMOST Registry Amendment Act permits the creation of an electronic database of advanced directive wishes for District residents that can be tied into the health information exchange.
- Mayor Bowser signs into law the School Sunscreen Safety Temporary Amendment Act of 2019. The bill permits students to bring and apply sunscreen during the 2019-2020 school year.
- MSDC comments on the importance of funding United Medical Center (UMC) and health facilities in Wards 7 and 8 in the mayor's budget. Those comments are used almost verbatim in CM Trayon White's comments advocating for funding of United Medical Center.
Scope of Practice
- DC Health publishes draft regulations removing the 3 mandatory CME hours for HIV/AIDS awareness and replaces them with a requirement to fulfill 10% of mandatory CME hours with a topic from a public health priority list. DC Health then waived the requirement for 2020.
- The Strengthening Reproductive Health Protections Act of 2020 is signed into law with MSDC support. The bill prohibits government interference in reproductive decisions between a patient and doctor, and prohibits employers from penalizing physicians for practicing reproductive medicine outside of their work hours.
- The Mayor's Commission on Healthcare Systems Transformation releases its final recommendations. One recommendation is for the District to explore options to make providing health care more affordable, including financial relief for higher malpractice insurance rates.
- The Council removes "telephone" from the list of prohibited types of telemedicine to allow physicians and other providers to be reimbursed for telephone telemedicine appointments after MSDC and health community advocacy.
- MSDC worked with the Council to modify onerous language in the Health Care Reporting Amendment Act that potentially would have penalized physicians from seeking help for substance abuse or addiction issues.
Opioid/Drug Policy
- The Department of Health Care Finance (DHCF) waives prior authorization for key medication assisted treatments (MAT) treating substance use disorder patients in Medicaid.
- The Mayor signed into law The Access to Biosimilars Amendment Act of 2019, a top MSDC priority as it would help prescribers to prescribe more cost-effective drugs for patients.
Behavioral Health
- The Behavioral Health Parity Act of 2017, a major priority for MSDC and DCPA, officially becomes law. The legislation requires all health benefit plans offered by an insurance carrier to meet the federal requirements of the Wellstone/Domenici Mental Health Parity and Addiction Equity Act of 2008.
Health Equity
- The District Council passes B22-1001, The Health Insurance Marketplace Improvement Amendment Act of 2018. The bill prohibits the sale of Short Term, Limited Duration health plans and Association Health Plans (AHPs) in the DC Health Benefits Exchange.
Scope of Practice
- DC joins 28 other states in the Interstate Medical Licensure Compact with B22-177 becoming law. The IMLC is designed to ease physician licensure in multiple states.
Women's Health
- The Maternal Mortality Review Committee is established by law. The Committee is responsible for finding solutions to maternal health crisis in the District. District physicians are an important part of this vital committee.
- B22-106, The Defending Access to Women's Health Care Services Amendment Act, becomes law. The act requires insurers to cover health care services like breast cancer screening and STI screenings without cost-sharing.
Opioid Policy
- Right before the Council adjourned for the session, it passed B21-32, the Specialty Drug Copayment Limitation Act. The bill limits cost shifting by payers for prescription drugs.
Behavioral Health
- B21-0007 passes the Council. The Behavioral Health Coordination of Care Amendment Act of 2016 permitted the disclosing of mental health information between a mental health facility and the health professional caring for the patient.
Women's Health
- MSDC was proud to have worked on B21-20. The law requires payers to cover up to 12 months of prescription contraception, advancing women's health and equality.
MSDC and Coalition Partners Send Letter in Support of Copay Accumulator Legislation
On the day of its committee hearing, MSDC and coalition partners sent a letter to Chair Vincent Gray supporting B24-557, the Copay Accumulator Amendment Act. The legislation is strongly supported by MSDC as a way for patients who rely on specialty drugs to treat their conditions, and who may have high out-of-pocket costs or high deductibles they are required to meet.
The legislation was introduced last year by Councilmember Mary Cheh and four colleagues. The bill would require health insurers to apply discounts, financial assistance, payments, product vouchers and other reductions in out-of-pocket expenses made by or on behalf of a member when calculating the member’s coinsurance, copayment, cost-sharing responsibility, deductible, or out-of- pocket maximum for a covered benefit.
The text of the letter is below.
June 27, 2022
The Committee on Health
Council of the District of Columbia
1350 Pennsylvania Ave NW
Washington, DC 20004
Re: hearing on B24-557
Dear Chair Gray,
Thank you for holding this hearing on B24-557, the Copay Accumulator Amendment Act. The bill will positively impact residents who rely on specialty drugs to treat their conditions, and who may have high out-of-pocket costs or high deductibles they are required to meet.
In recent years, health insurers and pharmacy benefit managers have been implementing new programs called “copay accumulator adjustment programs” that do not count payments from copay assistance toward patients’ deductibles and out of pocket maximums. In other words, the assistance is not actually helping patients afford their high-cost treatments, forcing them to choose between their health and financial stability.
B24-557 will help residents continue to access the treatments they need by requiring that all payments made by or on behalf of a patient count toward their cost sharing obligations.
Deductibles have been outpacing inflation for over a decade and the COVID-19 pandemic has only exacerbated the financial strain that these high deductibles and out-of-pocket costs put on patients and their families. To maintain their health and quality of life, patients turn to copay assistance from manufacturers and nonprofits to afford their medications
For people with arthritis, cancer, HIV, MS, psoriasis, and other chronic conditions, specialty medications are often the only effective treatment options available. The specialty medications required to manage these complex conditions are consistently placed on the highest cost-sharing tier of health plan and pharmacy benefit manager formularies. When facing high out-of-pocket costs, patients do not use their medications appropriately, skipping doses to save money or abandoning treatment altogether. Unfortunately, patients who stop using their medications due to high costs end up having more emergency room visits and negative health outcomes, which increases overall health care costs.
Insurance carriers and pharmacy benefit managers have said that copay accumulator adjustment programs reduce health care spending by encouraging patients to try cheaper alternatives; however, when patients do not have access to the medications they rely on, health care spending increases. A vast majority of copay assistance is used for treatments that do not have a generic alternative. Patients often do not realize their copay assistance was not counted toward their deductible or out-of-pocket maximum until they are told they owe hundreds or thousands of dollars at the pharmacy.
B24-557 will ensure residents who rely on specialty medications can continue to access their treatments through the help of copay assistance. This is especially important as deductibles continue to rise. We understand that there are many factors contributing to the cost of health care, but patients should not be punished for using copay assistance to help them afford the treatments they need.
We urge you to help DC join 14 other states that passed legislation on copay accumulators and protect residents’ health.
Sincerely,
MSDC
American Diabetes Association
Aimed Alliance
ASCO
Chronic Disease Coaltion
DC Rheumatology
Hemophilia Association of the Capital Area
Hemophilia Federation of America
HIV + HEP Policy Institute
Lupus and Allied Diseases Association
Alliance for Patient Access
ALS Association
Arthritis Foundation
Washington Psychiatric Society