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Pennsylvania State Senate
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=S&SPick=20190&cosponId=26937
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Senate of Pennsylvania
Session of 2019 - 2020 Regular Session

MEMORANDUM

Posted: December 10, 2018 03:22 PM
From: Senator Bob Mensch
To: All Senate members
Subject: Specialty Tier Drug Co-payment Caps
 
In the near future, I will be reintroducing 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.

Thus far, eighteen states, including Pennsylvania, 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.
As you see above, the PA legislature has previously taken the initiative to conduct a study of specialty tier drug pricing. It is now the time to implement some of the Legislative Budget and Finance’s recommendations.

I hope you will join me in co-sponsoring this legislation to cap the highest co-payments for medications and to more evenly distribute the pharmacy costs between enrollees and insurers.

If you have any questions please contact Mark Fetzko at 717-787-3110.



Introduced as SB484