Insurance Updates and Cost-Saving Legislation

Insurance Updates and Cost-Saving Legislation

Take Action! If you or someone you know suffers from pulmonary hypertension (PH), then you have a powerful story to tell. Share yours on April 16, PHA's National Call-In Day. Tell your Members of Congress about the need for better access to treatment and urge them to co-sponsor the Patients' Access to Treatments Act (PATA).

With the ever-changing landscape of healthcare policies, it's important to stay up to date. Here are some recent insurance and healthcare updates:

1. Patient's Access to Treatments Act (PATA)
   A bipartisan bill that will limit costs for medications placed in a specialty tier, was introduced on March 25, 2015. The legislation seeks to make life-saving medications more accessible by reducing excessive out-of-pocket costs.
   
   PHA is one of 32 members of the Coalition for Accessible Treatments, which encourages patients, caregivers and physicians to ask lawmakers to support and co-sponsor the bill. See the sidebar to learn how you can take action to advance this important legislation.
2. ACA Enrollment ChangesThe Obama administration announced a change to the 2016 Affordable Care Act open enrollment period late last month. The open enrollment period for 2016 health insurance Marketplace plans will run from Nov. 1, 2015 to Jan. 31, 2016. This is a change from the 2015 open enrollment period, which ran from Nov. 15, 2014, to Feb. 15, 2015.
    
3. Medicare Network DirectoriesThe Center for Medicare & Medicaid Services (CMS) now requires Medicare Part C (Medicare Advantage) and Part D (prescription drug plan) providers to update their network directories four times a year.
   
   Previously, out-of-date directories were resulting in higher out-of-pocket costs and, in some cases, outright denials of coverage. Updated directories will also prevent situations where beneficiaries make plan selections based on a plan's network directory, only to find out that their preferred choice is not accepting new patients. If plans are found to have inadequate or outdated lists, the insurance providers can be fined or subject to sanctions that prohibit them from enrolling new members.