Kentucky recently took a stand and became the first US state to pass legislation allowing charities to help patients pay for their healthcare costs, including insurance premiums.
Senate Bill 44, sponsored by Senator Ralph Alvarado and Rep. Kim Moser, passed in 2021 and was enhanced and updated with one minor change (SB 317) in 2022. Accessia Health (formerly Patient Services Inc.) was proud to lead the lobbying efforts to secure this victory for patients. Accessia Health is a non-profit patient support organization serving people with rare and chronic diseases. Our 30+ year mission is to provide financial support and advice to qualified individuals by providing healthcare education, financial aid, specialized legal services and case management.
When we launched this needs-based model, we sought advice from the Office of the Inspector General (OIG) to ensure that if we seek donations from pharmaceutical companies to help pay for healthcare for patients with diagnoses specific, we would not see any repercussions of the Anti-bribery law. We received the first advisory opinion from the OIG in 2002 and a 2017 amendment to this advisory. These advisory opinions establish the framework within which Accessia Health operates. We ensure that each patient is treated fairly and consistently in accordance with established eligibility criteria and that our donors are “hands-off” in our operations, including recommending or requiring drug purchases or use from a pharmaceutical donor.
That’s why it was so surprising that an insurance payer withheld our payments on a patient’s behalf saying that we are inducing patients to use expensive drugs or seek more expensive treatments. Many productive conversations took place, especially with some insurers who were unaware of the regulatory framework in which non-profit patient support organizations like Accessia Health operate. Once they understood the regulatory safeguards in place, payers agreed that nonprofit organizations can legally provide health insurance premiums and cost sharing to help patients receive the care they need. need.
Fast forward to today: Kentucky is the first state to adopt the nonprofit patient assistance model as a legitimate and compassionate way to provide financial assistance to people who cannot afford to pay for their health care. The bill as passed (which applies to health benefit plans issued or renewed on or after the law’s effective date of March 29, 2022) specifically recognizes patient support organizations that operate pursuant to an OIG advisory opinion as legitimate charitable resources, authorized to pay for the health care needs of those who are financially eligible. Kentucky insurers seized the legislative opportunity to work with charitable patient assistance programs to address high drug costs for their policyholders, shortly before America’s Health Insurance Plans (AHIP), the national association representing health insurance schemes, echoes this sentiment.
In a recent legal deposit, AHIP has taken the position that pharmaceutical companies should agree to work with bona fide patient aid charities that have adopted regulatory safe harbors under specific OIG notices. The document states that “anti-bribery law, as interpreted by the Department of Health and Human Services (HHS), does not require a finding of impermissible intent to induce purchase whenever someone pays for a portion of someone else’s medical care, even though that charitable support allows the patient to access federally funded health care services that they would not otherwise have access to. Families, friends and independent charities have no financial interest in the medical items a patient chooses to purchase and do not limit patient choices to any product they sell. This makes it highly unlikely that they possess the required “deliberate intent”.
We agree with AHIP in this conclusion and will work with payers and pharmaceutical manufacturers to ensure that eligible patients can access the healthcare they need, thereby reducing additional long-term strain on the healthcare system in the United States.
Almost 50% of US chronically ill patients have been unable to pay direct medical costs in the past year. We commend Rep. Moser for championing the 2022 Commonwealth Patient Charge, as well as the Kentucky Legislature and the health insurance industry, as passing this important legislation is the first step to lowering this statistic. .
In 2020, Accessia Health provided more than $1.27 million in assistance to 447 Kentucky patients. Your support is crucial to help us continue to provide this essential financial lifeline.
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