top of page

Newsroom

AJC logo.jpg

Rural independent pharmacies say vetoed bill shakes their future

The Atlanta Journal-Constitution

 

 

Residents of rural Tate, Georgia lost their only retail pharmacy this February, one of at least three independent pharmacies in the state that have gone out of business this year. Katie Bell, who owned Bell’s Family Pharmacy in Tate, says they all had a common problem: the middlemen that employers like the state of Georgia hire to manage their medical insurance drug costs.

As a slate of new state laws start going into effect today, a bill that legislators passed to address that problem will not be among them. Senate Bill 198 passed the Georgia House and Senate almost unanimously, with only one vote against it, but was vetoed by Gov. Brian Kemp in May. He cited the high cost of raising reimbursements for the small pharmacies, which was not accounted for in the state budget.

The middlemen, known as pharmacy benefits managers, negotiate prices for drugs for employers and claim that their work is all that stands between employers and outrageous drug prices set by drugmakers. Supporters of the independent pharmacies claim that using a benefits manager actually costs employers money and threatens small businesses that don’t have the same negotiating power. Both groups question the others’ data, saying it’s not complete.

Keep reading

Georgia Recorder.png

Opinion - Georgia failed to put patients first by not holding pharmacy middlemen accountable

The Georgia Recorder


As Georgians struggle to feed their families and afford housing, many are now having to balance affording basic necessities with paying high costs at the pharmacy counter. While Georgia lawmakers are rightly looking for solutions to ease the burden of high health care costs, industry middlemen, known as pharmacy benefit managers (PBMs), have flown under the radar and are getting away with intentionally increasing costs for patients. Yet state lawmakers missed an opportunity during the 2023 legislative session to reform a system that continues to allow insurers and other middlemen to pocket medication discounts that are intended to lower costs for Georgia patients.

With 6 million Georgians living with at least one chronic disease, many Georgia patients rely on frequent dosages of medications to manage their health and symptoms. Chronic conditions, such as lupus or multiple sclerosis, require consistent medication. However, nearly 70% of Georgia adults have reported confronting burdensome health care costs. We cannot continue to let Georgians fall behind on health care they need.

Keep reading

1609805520210-removebg-preview.png

Opinion - State lawmakers should put patients first and stop predatory pharmacy middlemen

The Augusta Press

 

Profit-driven middlemen called pharmacy benefit managers, or PBMs, which are owned and operated by insurance companies, insert themselves between your doctor and your pharmacist, making decisions that can cost you money restrict access to certain medications. While they were originally created to negotiate better prices and streamline care, PBMs have strayed far from their intended purpose.

After negotiating lower drug prices, PBMs and insurance companies are pocketing the profits, rather than passing the savings along to patients. And while patients have been forced to pay higher and higher costs, PBMs earned record profits – over $200 billion in 2021 alone.

This is especially important to patients who require specific medications but don’t have access to cheaper generic alternatives. In these cases, prescriptions could cost tens of thousands every month. The result? Many patients in Georgia and across the country refrain from taking their medications, cut their pills in half, or will intermittently take their medications.

Keep reading

WRDW.png

Local doctor, Georgia representative call for lower medicine costs

WRDW

It’s a practice that’s supposed to help insured patients save money on their medication, but one doctor says her patients are digging deeper in their wallets for name-brand medicine.

A Georgia bill that would stop the middleman from making a profit off saving you money on prescriptions could change that.

The purpose of a benefits manager, also known as the middleman between your doctor and your preferred pharmacy, is to negotiate the cost of prescription drugs.

But the problem, the middleman gets paid depending on how much savings they carve out.

Read more

download.png

ICYMI - Georgia General Assembly Passes Significant Health Parity Legislation

Georgia state lawmakers passed legislation that strengthens access to mental health and substance use services in Georgia.

 

The Mental Health Parity Act (House Bill 1013) makes a host of major changes to Georgia's mental health system. House Speaker David Ralston was a major supporter of legislation that would ensure Georgians can access the affordable mental health and substance use disorder treatment that they need for themselves and their children. 


The bill includes steps to increase the number of behavioral health and substance use providers throughout the state, especially in rural areas, increase Medicaid payments for certain providers, and improve data collection so state leaders will better understand the true workforce shortages. 

 

The 41 members of the Rx in Georgia Coalition worked tirelessly advocating for this legislation and on behalf of hundreds of thousands of patients represented across the state. 
 

Rx in Reach thanks Speaker Ralston for his continued support on this important legislation and ensuring that mental health is treated equally to physical illnesses by health insurers. 

Click here to watch Rx in Reach and other Georgia advocates thank Speaker Ralston at the Georgia General Assembly.

Fresh take GA 800x800.png

Lawmakers weigh proposal to lower prescription drug costs in Georgia

Fresh Take Georgia

 

March 16, 2022 -  When Bernice Isaac arrived at her local pharmacy to pick up a new hormone imbalance medication in January, she was stunned to see a $310 price tag. 

The Marietta resident is no stranger to prescription medication — she suffers from what she says is a “laundry list of illnesses,” including diabetes, lupus and kidney disease. But even after years of budgeting for her prescriptions, Isaac said the price hurt. 

“That’s a lot to ask somebody to pull out of the air to get a prescription that’s necessary,” Isaac said. “It’s a lot of money to be hit with on the first of the year, right after the holidays.”

A new bill aims to lower the cost of some brand name prescription drugs for insured patients by increasing transparency in medication pricing for Georgians, said state Rep. Mark Newton, the sponsor of HB867. 

 

Click Below To Read The Full Article

Georgia Health News.png

For many, insurance doesn’t prevent high costs from prescriptions

Georgia Health News

April 20, 2021 -  Prescription drug spending is climbing, and represents roughly 10 percent of overall health care spending. The spending increase is linked to prices, utilization and new drugs.

The new drugs include biologics, which are derived from living cells and typically cost more because of a complex manufacturing process.

These drugs “are what you see advertised on TV,” Perri says, and include medications for rheumatoid arthritis, cancer and Crohn’s disease. 

Dorothy Leone-Glasser of the Rx in Reach GA Coalition, a collaboration of consumer advocacy and medical groups, is among the people with a high monthly drug tab. 

“One of my drugs is more than $700 a month, says Leone–Glasser. “Even with prescription drug coverage, if you have a chronic illness, it’s not going to cover all the drugs for your illness.’’

Click Below To Read The Full Article

AJC-logo.png

Opinion: Let pharmacists keep giving vaccines

Atlanta Journal-Constitution

by Bishop Reginald Jackson

The COVID-19 pandemic has had a disproportionate impact on Georgia’s Black communities since it began a year ago. Unfortunately, we continue seeing the disparities as immunization rates for Black Americans lag behind other races amid the abysmal vaccine rollout in Georgia. While COVID-19 has killed about 1 out of every 800 Black Americans, Georgia struggles to get vaccines to Black communities. We need the Georgia legislature to act now and increase access to COVID-19 vaccines in underserved areas by allowing pharmacists to administer all U.S. Food and Drug Administration (FDA)-approved vaccines.

Georgia has remained among the worst states in terms of getting the COVID-19 vaccine to those who need it. The rollout of the vaccine has been riddled with complications, confusion, and delays, resulting in only about 12 percent of the Georgia population having been vaccinated. And when we look at who is getting the vaccine, the numbers are even worse for Black residents.

Of the nearly 4 million doses delivered, only about 22 percent of vaccines have gone to Black Georgians, despite making up a third of Georgia’s population. While part of the lag in immunizations can be blamed on supply, the fact is, Black communities are being left out and current disbursement strategies lead to gaps in vaccine access while deepening the mistrust Black Georgians have regarding the COVID vaccine.

Click Below To Read The Full Op-Ed

 

download.png

Dorothy Leone-Glasser, Executive Director of Advocates for Responsible Care (ARxC), Featured in Georgia Health News Article on Drug Pricing

Giving consumers a price break on prescription drugs is the focus of House Bill 164.

State Rep. Demetrius Douglas (D-Stockbridge) told a House committee Tuesday about his proposal to give consumers with individual insurance policies at least 80 percent of the rebate that the drug companies pay insurers or PBMs (pharmacy benefit managers).

A PBM is a corporate entity that basically serves as a middleman between health insurers or large employers and drugmakers in handling pharmaceutical benefits.

Typically, a Democrat-sponsored bill has little chance of moving in the Republican-controlled General Assembly, but this one has Rep. Sharon Cooper (R-Marietta), who chairs the House Health and Human Services Committee, as a co-sponsor.

Douglas, at a Tuesday hearing of House Special Committee on Access to Quality Health Care, cited the effect of high drug prices on working families during the pandemic. People with diabetes pay steep costs for insulin, he added.

Click Below To Read The Full Article

 

Georgia Health News.png

Blacks’ lower vaccination rates linked to distrust

Georgia Health News

February 8, 2021 -  Forty-three percent of Black adults say they would rather “wait and see” before getting vaccinated, compared to 31 percent in the general population, according to a recent Kaiser Family Foundation (KFF) survey. That’s down 9 percentage points from December. Twenty-one percent say they would definitely not get inoculated, unless required to do so for work, school or other activities.

 

While there are early signs of a decline in vaccine reluctance, actual vaccination statistics so far have shown a stark disparity in the percentages of African-Americans receiving shots.

According to a new demographic analysis from the CDC, Blacks and Hispanics are underrepresented among people vaccinated in the United States. In the first month of the national vaccine rollout, only 5.4 percent of recipients were Black, and 11.5 percent were Hispanic, although those demographic groups make up 13.4 and 16.7 percent of the population, respectively.

Click Below To Read The Full Article

 

584810c5cef1014c0b5e495b.png

Across The South, COVID-19 Vaccine Sites Missing From Black And Hispanic Neighborhoods

NPR

 

February 5, 2021 -  Communities of color have been disproportionately harmed by the COVID-19 pandemic. Now they're at risk of being left behind in the vaccine rollout.

Using data from several states that have published their own maps and lists of where vaccination sites are located, NPR identified disparities in the locations of vaccination sites in major cities across the Southern U.S. — with most sites placed in whiter neighborhoods.

NPR found this disparity by looking at Census Bureau statistics of non-Hispanic white residents and mapping where the vaccine sites were. NPR identified counties where vaccine sites tended to be in census tracts — roughly equivalent to neighborhoods — that had a higher percentage of white residents, compared with the census-tract average in that county. Reporters attempted to confirm the findings with health officials in nine counties across six states where the differences were most dramatic: Travis and Bastrop counties, Texas; East Baton Rouge Parish, La.; Hinds County, Miss.; Mobile County, Ala.; Chatham County, Ga.; DeKalb County, Ga.; Fulton County, Ga.; and Richland County, South Carolina.

Click Below To Read The Full Article

 

download.png

Rx in Reach COVID-19 Vaccination Survey Results

January 5, 2021 - Rx in Reach surveyed Georgia Residents about the COVID-19 vaccines, and sought to help gain some perspective on attitudes and beliefs about the newly released COVID-19 vaccines among Rx in Reach coalition constituents and the general public. 

The survey showed four key points: 

  • Many people are ready to be vaccinated.

  • There are concerns about the safety and efficacy of the vaccine.

  • Online media and healthcare providers will likely play a large role in information our population.

  • The public is looking for guidance and information on the COVID-vaccine rollout and distribution.

Rx in Reach looks forward to working with elected leaders to improve the distribution and understanding of the COVID-19 vaccine. To read the full results, please click below. 

 

download.png

Rx in Reach COVID-19 Vaccination Survey - Help Us Understand Your Opinions

The Advocates for Responsible Care (ARxC), a non-profit patient advocacy organization in Atlanta, GA, created this survey with Rx in Reach GA. We would like to hear from you and other Georgians about your opinions of the new COVID-19 vaccines and your plan to get vaccinated. Information gained from this survey will help us understand how we can inform Georgians about the vaccines and how to get vaccinated. 

YOU MUST BE AT LEAST 18 YEARS OF AGE OR OLDER AND A RESIDENT OF GEORGIA TO TAKE THIS SURVEY.

This survey will take around 5 minutes to complete. It is entirely voluntary. You are free to exit the survey at any time and may choose not to answer some or all of the questions. Your information will not be linked to you.
 
If you have any questions or concerns regarding the survey, please contact us at dlg@arxc.org.  

 

Best-Practices-that-Increase-Over-Time-V

Dorothy Leone-Glasser, Executive Director of Advocates for Responsible Care (ARxC), to be Featured on Panel During Georgia Bio Innovation Summit

Join Dorothy Leone-Glasser and other experts at the Georgia Bio Innovation Summit November 4-6. Leone-Glasser will be featured on a panel discussion regarding "Best Practices that Increase "Over-Time" Virtual Patient Engagement." Join her virtually on November 5, 2020 at 8:30 am. Click below for full details or visit www.georgiabiosummit.org

Fun Rx in R Coalition.jpg

40 Georgia Patient & Physician Groups Urge Governor Kemp to Sign PBM Reform

Atlanta, GA (July 20, 2020) – Forty Georgia patient and physician groups, led by the Rx in Reach GA Coalition, today urged Governor Brian Kemp to sign Senate Bill 313 and House Bills 946, 918, and 991 which work together to tighten regulations of pharmacy benefit managers (PBMs) and increase patient access to medications. PBMs are little-known middlemen who profit in the health care system by negotiating between health insurers, drug manufacturers and pharmacies, often resulting in confusing policies and higher prices for patients. 

Due to the efforts of Sen. Dean Burke, and Reps. David Knight, Sharon Cooper and Matt Hatchett, these bills passed the Georgia General Assembly with strong bipartisan and bicameral support. The bills will lead to improved patient access to prescription medications and financial relief for patients. The legislation requires that PBMs pass on savings from their negotiations to health care plans, and also requires that any copay assistance that patients receive for generic medications is applied towards the patient’s cost-sharing or copay responsibilities.  

Click below to read the full letter.

download.png

40 Georgia Patient & Physician Groups Applaud Passing
Legislation to Tighten Regulation of Pharmacy Benefit Managers

Atlanta, GA (June 25, 2020) – Forty Georgia patient and physician groups, led by the Rx in Reach GA Coalition, today applauded the Georgia General Assembly for passing Senate Bill 313 and House Bills 946, 918, and 991 which work together to tighten regulations of pharmacy benefit managers (PBMs) and increase patient access to medications. PBMs are little-known middlemen who profit in the health care system by negotiating between health insurers, drug manufacturers and pharmacies, often resulting in confusing policies and higher prices for patients. 

“Thanks to the efforts of Sen. Dean Burke,  and Reps. David Knight, Sharon Cooper, and Matt Hatchett, Georgia patients will now have more choice in where to get their prescriptions and at a lower cost,” said Dorothy Leone-Glasser, RN, HHC, the Executive Director of Advocates for Responsible Care, which leads the Rx in Reach GA Coalition. “PBMs have complicated the prescription drug market for too long, and this legislation is an important step towards helping patients access the prescription drugs and treatments they need. We look forward to Governor Brian Kemp signing these bills into law.” 

Click below to continue reading the full press release. 

Pharmacists' hands

Georgia House tightens regulations on prescription drug pricing

The Citizens

 

ATLANTA - Third-party companies that help set prescription drug prices would face tighter regulations under identical bills the Georgia House of Representatives and state Senate passed unanimously Monday.

Pharmacy benefits managers (PBMs) negotiate between insurance companies and pharmacies to set drug prices.

But too often, PBMs hide behind unscrupulous practices that allow them to increase prices without sufficient oversight, said Rep. David Knight, R-Griffin.

Senate Bill 313, which cleared the state Senate in March, follows legislation the General Assembly passed last year to prevent PMS from steering patients to associated pharmacies with potentially higher costs.

The House amended this year’s bill as it went through the committee process to make it identical to House Bill 946, PBM legislation the House passed, also in March.

 

Click below to continue reading the full article. 
 

Vitamins and pills

Pharmacy steering detrimental to patient care

The Newnan Times-Herald

 

I purchased Lee King Pharmacy because I wanted to provide world-class care for people in my community with a personal touch.


Since purchasing the pharmacy in January of this year, I have had the privilege of providing care under the most trying health care crisis this country has seen in our lifetime.

 

In doing so, I have seen the best this country has to offer from physicians, nurses, pharmacists and pharmacy technicians. I have also seen it from our patients and their relatives and loved ones, who are willing to go the extra mile to stay healthy and safe.


But I have also seen a darker side to America’s health care system – PATIENT STEERING. During this COVID-19 pandemic, I’ve had more than 15 patients who were steered from my pharmacy to pharmacies owned or affiliated with the patient’s insurance company or their pharmacy benefits manager.


To be clear, these are patients, who are often very sick with chronic diseases including cancer, who chose my pharmacy, who traveled to my pharmacy, who needed drugs, and who were told, at the height of the pandemic, that they had to receive their drugs from a mail order pharmacy (delaying treatment up to three weeks) or retail chain pharmacy affiliated with the insurer or PBM.

 

Click below to continue reading the full article. 
 

Dr. Jennifer Shannon.jpg

Letter to the Editor: Legislation would give Georgians with greater choice in healthcare

John's Creek Herald // NorthFulton.com 

 

As our state continues to combat the effects of the coronavirus, the ability to access high-quality health care is an issue at the forefront of the minds of many Georgians. Independent pharmacists have long played a critical role in providing personalized care to our communities, but because of roadblocks faced by some community pharmacists, too many of Georgia’s patients are now being forced to wait for critical medications. To ensure Georgians can access the care they need, lawmakers must act to protect the important role of community pharmacies, which are more critical than ever amid the coronavirus.

As a clinical pharmacist and the owner of Lily’s Pharmacy in Johns Creek, I know first-hand the important role independent community pharmacists play in delivering high-quality, personal care to our patients. But as pharmacy benefit managers (PBMs), little-known middlemen in the health care system, have gained outsized power and influence, it has become increasingly difficult for community pharmacists to deliver care in a timely manner.

PBMs manage drug benefits for 95 percent of Americans with prescription drug coverage, and most PBMs also own a mail order pharmacy. PBMs, therefore, have the power to financially penalize nearly every patient that chooses to use their community pharmacy instead of the PBM mail order pharmacy. This abuse at the pharmacist care-level by PBM mandates has led to the closing of many locally owned pharmacies. And a lack of patient choice and personal care is having very real consequences, with many pharmacists across Georgia are being prevented from filling patients’ medications because of PBM mandates.

Fortunately, the Georgia General Assembly is considering Senate Bill 313 and House Bill 946, which propose new regulations to provide oversight to PBMs. When the Georgia General Assembly resumes session in June, lawmakers must act to swiftly pass this important legislation and ensure Georgians can receive timely care, including treatments for COVID-19.

For too long, PBMs have operated unchecked, prioritizing their bottom lines over the health and wellbeing of Georgians. Now, lawmakers in Atlanta have the opportunity to enact legislation that will both ensure patients can access the medications they need, when they need them, and protect the important role of community pharmacists

DLG.png

Atlanta Business Chronicle Names Dorothy Leone-Glasser as a 2020 Health Care Hero

The Atlanta Business Chronicle

 

by H.M. Cauley

 

It is no question that the health-care industry is full of people who, day after day, pandemic or no, work tirelessly to heal their patients. In this current climate, the world is paying even more attention to these doctors, nurses, allied health professionals, physical therapists and others who many consider heroes.

Nominated by their peers and colleagues and chosen by members of Atlanta Business Chronicle’s editorial staff, these health-care professionals are our Health Care Heroes for 2020. 

COMMUNITY OUTREACH

Winner: Dorothy Leone-Glasser, Advocates for Responsible Care (ARxC)  

Click below for the full article. 

Dorothy wishes to thank the The Pfizer Foundation for their generosity to continue the great work of ARxC. 

pills-1021444_1280.jpg

Georgia bill seeks lower drug prices by focusing on middlemen

The Atlanta Journal-Constitution

 

by Ariel Hart

 

In an effort to attack high drug prices, Georgia lawmakers are focusing on powerful middlemen who negotiate on behalf of insurance companies.

State Sen. Dean Burke, R-Bainbridge, has introduced a bill that aims to shed light on prices that pharmacy benefits managers negotiate with pharmaceutical companies and pharmacies, and to ensure that patients are able to get the drugs when they need them. The legislation is Senate Bill 313.

Image by Volodymyr Hryshchenko

Your Support Needed: SB 313 Has Critical Hearing on February 12, 2020

Support SB 313, An Act to Provide Oversight and Regulation of PBMs

 

We need to fill the room on Wednesday, February 12, 2020, to get SB 313 on PBM oversight passed! SB 313 is being heard in the Senate Insurance & Labor Subcommittee on Wednesday, February 12, 2020 at 1:00 pm in Room 310 of the Coverdell Legislative Office Building. 

If you have a PBM story or if your physician can come to speak, please contact Dorothy Leone-Glasser, RN, HHC immediate: email dlg@arxc.org or call 404-633-5843.

We need the Senate subcommittee to see patient advocates who care that PBMs are blocking their access to prescription drugs and treatments.

This cannot happen without you!

 

Click here to read the legislation.

 

Coverdell Legislative Office Building

18 Capitol Square SW

Atlanta, GA 30334

Image by Kendal

PBMs: Power brokers in the prescription drug world

Georgia Health News

 

by Andy Miller

 

Pharmacy benefit managers (PBMs) are major contributors both to ballooning prescription drug prices and the lack of transparency around it.

 

Yet, if you’re like many Americans, there’s a good chance you’ve never heard of them.

 

Although they are not physicians, drug makers, insurers, or pharmacists, these companies play an outsized role in our healthcare system, making medical decisions including which prescription drugs you may take – and also how much you’ll pay for them.

Image by Sharon McCutcheon

The Middlemen Getting Rich Off Your Prescriptions

Even when drug companies cut prices by over half, patients pay too much

 

by Dorothy Leone-Glasser, RN, HHC.

 

Pharmacy benefit managers (PBMs) are major contributors both to ballooning prescription drug prices and the lack of transparency around it.

 

Yet, if you’re like many Americans, there’s a good chance you’ve never heard of them.

 

Although they are not physicians, drug makers, insurers, or pharmacists, these companies play an outsized role in our healthcare system, making medical decisions including which prescription drugs you may take – and also how much you’ll pay for them.

newsEngin.23977562_022319-leg-ralston-ba

Georgia Legislature’s impact on health care this year was ‘pretty big’

ATLANTA JOURNAL-CONSTITUTION

Insurance companies are increasingly using their power to push back against rising health care costs. And the doctors and hospitals who bill those costs increasingly say they’re going too far, meddling in medical decision making.

“Step therapy” is one such instance, where an insurance company says a patient can’t have a medicine his or her doctor prescribed right away, at least not paid for by insurance. First, the company says, the patient must try a cheaper alternative. If that doesn’t work, then the patient might step up to the one prescribed by the doctor.

]

A bill passed in the state Legislature this year attempts to compromise. House Bill 63 says patients can avoid step therapy with a “step therapy exception” in certain cases. Those include whether the drug “is expected to be ineffective” based on the patient’s condition and the drug’s characteristics, or if it will cause physical or mental harm to the patient.

Woman & Doctor

Gov. Kemp signs bill to limit ‘Fail First' insurer decisions for chronic conditions

FOX 5 ATLANTA

Gov. Brian Kemp moved to limit a health insurance process known as "Step Therapy" when treating chronic conditions on Thursday.

The process, also known as "Fail First," forces patients to try older, often less expensive medications to prove those medications won't work.

Prescription Drugs

Atlanta Journal Constitution:
Fixing ‘Step Therapy’ can help solve pain crisis

BY REP. KIM SCHOFIELD

Chronic pain and how to treat it in the midst of the opioid epidemic has been a topic of national importance for quite some time now – and rightly so. But missing from the national debate has been the role insurance companies can, and should, play in covering non-opioid treatments for pain.

To save money, health plans often require people to “fail first” by trying and failing on therapies other than what their physicians have prescribed. This process, called step therapy, can mean weeks, months or even years without appropriate treatment. Meanwhile, people like me continue to suffer the symptoms of chronic disease and even unwanted side effects of the insurer-preferred medications.

Hospital Corridor

GA lawmakers consider bill giving doctors more say in prescriptions over insurers

ATLANTA (WJBF) - The concept is basic, what you expect when you go to the doctor. Your doctor prescribes the medication that will help you get better, right?

In Georgia...wrong.

Georgia law doesn't ban step therapy, which allows insurers to make you try older, cheaper drugs before the new ones your doctor prescribes.

"What they wanted our epileptic patients to do was to fail twice on two different kinds of medication before they would give them the medication that would keep their seizures in order. If you fail, and you're an epileptic and have seizure, you lose your drivers license for 6 months. How does a father or mother support their family or get to school? It's so ridiculous," says Rep. Sharon Cooper.

Justice

Georgia House Passes Legislation to Reform Step Therapy Insurance Practice Requiring Patients to 'Fail First'

Atlanta, GA (Feb. 15, 2019) – More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded the state House of Representatives for passing House Bill 63 – legislation sponsored by Rep. Sharon Cooper (R-Marietta) to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes. In some cases, insurers even require step therapy when patients have already tried the insurer-preferred medications, or when those medications could cause their health to deteriorate. 

Justice

Georgia House Passes Legislation to Reform Step Therapy Insurance Practice Requiring Patients to 'Fail First'

Atlanta, GA (Feb. 15, 2019) – More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded the state House of Representatives for passing House Bill 63 – legislation sponsored by Rep. Sharon Cooper (R-Marietta) to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes. In some cases, insurers even require step therapy when patients have already tried the insurer-preferred medications, or when those medications could cause their health to deteriorate. 

whirledges-640x300.jpg

House panel backs curbs on ‘step therapy’ rules for medications

When Brannen Whirledge was diagnosed with ulcerative colitis at age 4, he was put on medications that failed to help him. He suffered continual vomiting and severe stomach cramps.

 

Then they found a medication that worked. Brannen’s symptoms went away.

 

But after six months, says his mother, Melissa Whirledge, the family’s insurer told them that it would no longer cover the effective medication until “he failed on other drugs that he had already failed on.’’

 

The family appealed that ruling, and Brannen, now 7, has received exceptions to the drug restrictions. He is doing well, his mother says.

 Scales of Justice

Georgia House Insurance Committee Unanimously Passes Legislation to Reform Step Therapy Insurance Practice

Atlanta, GA (February 13, 2019) - More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded the state House Insurance Committee and its chair, Rep. Richard Smith (R-Columbus), for unanimously passing House Bill 63 -- legislation sponsored by Rep. Sharon Cooper (R-Marietta) to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes.

WAGA.jpg

Georgia woman battles HMO's switch from insulin pens to syringes

SUWANEE, Ga. (FOX 5 Atlanta) - Carol Bolton, a Suwanee, Georgia mother of two, says her insulin KwikPen has helped her stay on top of her type 2 diabetes for more than a decade.

 

"There is nothing to it; it's so easy and quick," Bolton says. "You just take it out of your purse, adjust the insulin level and inject the insulin into your stomach."

 

But in early December, she says, she got a letter from her HMO, Kaiser Permanente of Georgia, telling Bolton she would have to switch from the insulin KwikPen back to the traditional vials and syringes.

download.png

More than 30 Patient & Physician Groups Applaud Georgia Legislation to Reform Step Therapy Insurance Practice 

Atlanta, GA (Jan. 28, 2019) – More than 30 Georgia patient and provider groups led by the Rx in Reach Coalition today applauded Rep. Sharon Cooper (R-Marietta) for introducing House Bill 63 – legislation to reform the insurance practice known as step therapy, which forces patients to try and fail on medications other than what their health care provider prescribes – and in some cases, happens even when patients have already tried the insurer-preferred medications or when those medications could cause their health to deteriorate. 

Preparing for Blood Test

1 in 4 doctors say prior authorization has led to a serious adverse event

It just keeps getting worse. That’s a major finding of an AMA survey of 1,000 practicing physicians who were asked about the impact prior authorization (PA) is having on their ability to help their patients.

 

More than nine in 10 respondents said PA had a significant or somewhat negative clinical impact, with 28 percent reporting that prior authorization had led to a serious adverse event such as a death, hospitalization, disability or permanent bodily damage, or other life-threatening event for a patient in their care.

bottom of page