Legislation Quick Search
07/30/2021 04:07 PM
Pennsylvania State Senate
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=S&SPick=20170&cosponId=21521
Share:
Home / Senate Co-Sponsorship Memoranda

Senate Co-Sponsorship Memoranda

Subscribe to PaLegis Notifications
NEW!

Subscribe to receive notifications of new Co-Sponsorship Memos circulated

By Member | By Date | Keyword Search


Senate of Pennsylvania
Session of 2017 - 2018 Regular Session

MEMORANDUM

Posted: December 20, 2016 03:03 PM
From: Senator Bob Mensch
To: All Senate members
Subject: Specialty Tier Drug Co-payment Caps
 
In the near future, I plan on introducing legislation that will cap co-payments for the out of pocket cost of specialty tier drugs. Many surrounding states have already taken steps to protect those that suffer from rare conditions such as hemophilia, hepatitis, multiple sclerosis, lupus, some cancers, rheumatoid arthritis and other serious chronic health issues from the high out of pocket costs.

As of right now, the Affordable Care Act individual’s maximum out of pocket costs are $6,600 per year for self only coverage and $13,200 for other than self-only coverage. I believe this is incredibly high. My legislation would limit a patients cost to $100 per 30 day supply of any single specialty tier drug and not exceed $200 per month.

This legislation will be similar to 18 states including Pennsylvania that have introduced or enacted legislation to help people with the cost of these life-saving drugs. They are as follows:
  • Vermont Enacted legislation that establishes an annual out-of-pocket limit for prescription drugs at $2,000/individual and $4,000/family.
  • Delaware Enacted law limiting copays to $150 per month.
  • Louisiana Enacted law limiting copays to $150 per month.
  • Maryland Enacted law limiting copays to $150 per month.
  • Maine Enacted law limiting copays to $3,500 per year.
  • New York Enacted law prohibiting specialty tiers.
  • Alaska Enacted law prohibiting specialty tiers under certain circumstances.
  • Pennsylvania Enacted law to study specialty tier prescription drug pricing.
  • Massachusetts Introduced bill limiting copays to $1,250 per year.
  • Illinois Introduced bill limiting copays to $100 per month.
  • Kentucky Introduced bill limiting copays to $100 per month.
  • Connecticut Introduced bill limiting copays to $100 per month.
  • Hawaii Introduced bill limiting copays to $150 per month.
  • Virginia Introduced bill limiting copays to $150 per month.
  • California Introduced bill limiting cost-sharing.
  • Rhode Island Introduced bill limiting copays to $100 per month.
  • Minnesota Introduced bill specifying specialty medicines.
  • West Virginia Introduced bill specifying specialty medicines.
We took the initiative as a legislature to conduct a study of specialty tier drug pricing and now is the time to implement some of the Legislative Budget and Finance’s recommendations.

I hope you will join me in co-sponsoring this legislation that will cap the highest co-payments for medications which will more evenly distribute the pharmacy costs between enrollees and insurers. If you have any questions please call Bill Joraskie at 717-787-3110.