Protecting Access to Disease Modifying Therapies in Montana

Commissioner Lindeen and MS Activist Deanna McCann

Many people living with MS rely on disease modifying therapies to delay and reduce symptoms of the disease. These medications can be very expensive, and high out of pocket costs can hinder access to treatment.

In Montana, and many other states, insurance plans typically cover these medications in specialty prescription drug tiers requiring patients to pay 20, 30, even 50 percent of the drug cost in co-insurance. The financial burden placed on patients relying on specialty tier medications is often much higher than cost-sharing for other tiers of prescription drugs and plan benefits.

An inquiry by the National MS Society and its activists resulted in a change that will make it easier for consumers to access the medications they need. The Montana Commissioner of Securities and Insurance, Monica Lindeen, investigated the cost-sharing structures proposed by insurers for 2015, and objected to some of the plans.  As a result, insurers now offer plan options with graduated co-pays, ensuring that consumers on those plans will pay no more than $250 per month for their disease-modifying MS therapies.

Press at the National MS Society office in Billings, MT

In addition, the Commissioner’s office will make sure healthcare navigators are trained to help individuals who need high cost medications select a health insurance plan that is best for their needs.

On Friday, October 10th, Commissioner Lindeen hosted a press conference at the National MS Society's office in Billings and invited MS Activist Deanna McCann to speak on behalf of people affected by MS and other chronic diseases. Deanna shared her story of being diagnosed as a young mother unable to pay the high cost for disease modifying medication and thanked Commissioner Lindeen for changing the way Montanans will pay for their specialty tiered medications. 

The work of activists like Deanna makes a difference in the lives of people affected by MS. The National MS Society continues to monitor insurance market plans across the country to ensure access to quality and affordable health care. As Deanna notes, “insurance coverage can be confusing to anyone.” With the help of MS activists, we can promote education, transparency, and access for people living with chronic conditions.

Read more about the press conference here.

Want to share your story? Ready to take action? Contact us!

Should health insurance plans be required to cover MS drugs?

Insurers in Washington are looking for ways to cut the cost of their individual plans. One option is to remove brand name drug coverage. Premera did that in its Lifewise catastrophic plan a few years ago, and when Regence and Group Health tried to counter by doing the same, the Insurance Commissioner's office stepped in to say that access to at least some brand name drugs must be available for those that need them.

To learn more about this trend, check out this recent article that cites the high cost of MS drugs as a reason why people need insurance coverage.

Celebrate The Affordable Care Act!

As we enjoy the anniversary of the Affordable Care Act and everything it is doing for all Americans, we need to keep in mind that the Law is being challenged from all directions, and most importantly – in the Supreme Court!  As this hallowed body deliberates the legality of various components of the bill, the rest of us stand to lose so much.

It is my naïve, hopeful, and somewhat educated belief that the Affordable Care Act will be upheld by the Supreme Court. However, that will not protect the Law from members of Congress and State government (including Washington’s own Attorney General and candidate for Governor) who want to see the accomplishments of the Affordable Care Act repealed.

 Among all of the wonderful aspects of this law, the special significance to the MS community is the protection of people with pre-existing conditions, which will fully take effect in 2014. This tenant of the Affordable Care Act alone makes this legislation the most significant legislation for people with chronic disease that we have ever experienced.

So next time someone criticizes “Obamacare”, remind yourself and them, what this law means to the MS Community. We DO Care!

 Remember – It’s Time for Action! Washington

Cheers – Holly