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2011 SESSION

11100716D
HOUSE JOINT RESOLUTION NO. 579
Offered January 12, 2011
Prefiled January 10, 2011
Directing the Joint Commission on Health Care to study impacts of cost sharing, coinsurance, and specialty tier pricing for prescription medications. Report.
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Patron-- O'Bannon
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Referred to Committee on Rules
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WHEREAS, in response to increasing prescription drug costs, many health plans and prescription drug plans have increased enrollee cost-sharing amounts, instituted coinsurance, and created specialty tiers, resulting in increased medication costs for patients participating in those plans; and

WHEREAS, the National Conference of State Legislatures reports that between 2000 and 2009, copayments for insured workers have increased 25 percent for generic drugs, 80 percent for preferred drugs, 59 percent for nonpreferred drugs, and 44 percent for fourth-tier drugs or specialty tier drugs; and

WHEREAS, many health plans and prescription drug plans now require individuals to pay a coinsurance or percentage of the cost of fourth-tier or specialty tier prescription medications; and

WHEREAS, fourth-tier or specialty tier medications often include medications for chronic diseases, including certain types of cancer, hemophilia, multiple sclerosis, myositis, neuropathy, arthritis, human immunodeficiency virus, and other diseases and disorders; and

WHEREAS, coinsurance, cost-sharing, and specialty tier pricing place significant and onerous financial burdens upon insured individuals with chronic health care issues requiring prescription medication, in many cases leading to decreased adherence or failure to take medications as prescribed, resulting in acute incidents and negative health outcomes; now, therefore, be it

RESOLVED by the House of Delegates, the Senate concurring, That the Joint Commission on Health Care be directed to study impacts of cost sharing, coinsurance, and specialty tier pricing for prescription medications.

In conducting its study, the Joint Commission on Health Care shall (i) determine the impact of cost sharing, coinsurance, and specialty tier pricing on access to prescription medications for chronic health disorders and (ii) identify and evaluate options for reducing any negative impacts of cost sharing, coinsurance, and specialty tier pricing, including but not limited to statutory limitations on cost sharing obligations for prescription medications.

All agencies of the Commonwealth shall provide assistance to the Joint Commission on Health Care for this study, upon request.

The Joint Commission on Health Care shall complete its meetings for the first year by November 30, 2011, and for the second year by November 30, 2012, and the chairman shall submit to the Division of Legislative Automated Systems an executive summary of its findings and recommendations no later than the first day of the next Regular Session of the General Assembly for each year. Each executive summary shall state whether the Joint Commission on Health Care intends to submit to the General Assembly and the Governor a report of its findings and recommendations for publication as a House or Senate document. The executive summaries and reports shall be submitted as provided in the procedures of the Division of Legislative Automated Systems for the processing of legislative documents and reports and shall be posted on the General Assembly's website.