A Big Win For California Patients And Consumers – “Refill Reminders” A “Go” – National Consumers League

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sg.jpgCalifornia’s Office of Health Information Integrity (CalOHII) just delivered a big victory for patients and consumers by expressly recognizing that sponsored medication adherence programs for a currently prescribed drug (commonly called “refill reminders”) do not require patient authorization in California. In publishing its long-awaited State Health Information Policy Manual, CalOHII takes a step to harmonize the state’s Confidentiality of Medical Information Act (CMIA) with the federal medical privacy laws and regulations (a.k.a., the HIPAA Privacy Rule).

For years now, due in part to privacy concerns, confusion has persisted within the healthcare community about the types of refill reminder programs that can legally run in California. In fact, California is the only state in the U.S. where pharmacies do not, to any meaningful degree, operate sponsored refill reminder programs. California consumers deserve the benefit of refill reminders that provide helpful information to patients about their prescription drugs. Patient access to this information is now guaranteed.

CalOHII’s publication of its Manual makes clear that California adopts the same approach that the U.S. Department of Health and Human Services (HHS) took in its 2013 final rulemaking and “Refill Reminder Guidance.” Under that HHS Guidance, pharmacies are able to provide their patients with sponsored refill reminders. NCL applauds CalOHII for clarifying that the CMIA should be interpreted consistently with the HIPAA Privacy Rule. With that clarification, NCL is hopeful that California pharmacies and their sponsors will jumpstart sponsored refill reminder programs. 

NCL is a longstanding supporter of refill reminder programs. NCL leads  “Script Your Future,” a public education campaign designed to raise awareness of the importance of taking medication as prescribed. Poor medication adherence is a major, and significantly under-appreciated, health problem. Studies establish that nearly three-out-of-four Americans do not take their medications as directed, which costs the healthcare system nearly $300 billion per year and results in almost 125,000 unnecessary deaths per year. To help combat this problem, most pharmacies, health plans, and doctors provide a broad range of patient-directed communications regarding prescription drug therapies, including communications that encourage patients to stay on prescribed therapy. The sponsored refill reminder programs endorsed by CalOHII in its Manual are a key part of these efforts in California.  

 As a founding member of the Best Privacy Practices Coalition, NCL is also a strong believer in the protection of medical privacy. However, medical privacy does not exist in a vacuum. NCL is pleased that CalOHII has arrived at a great middle ground that balances the need for information with privacy concerns of patients. This balance is a win for Californians.

King v. Burwell ruling will keep consumers insured (and healthy!)

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Health_Care_Law.jpgThe King v. Burwell ruling in favor of the Affordable Care Act (ACA) has allowed for approximately eight million consumers to keep their insurance coverage. In the King case, petitioners challenged the clause of the Affordable Care Act that stated subsidies are available to people who use an exchange “established by the State” to purchase insurance. 

Consumers living in the 34 states without state marketplaces are able to benefit from the subsidies because the Internal Revenue Service allowed people to receive assistance if they purchased a plan on the federally-run marketplace. The plaintiffs argued that subsidies by law are only given to people living in states with their own health insurance marketplaces. The ruling allows consumers in states where the marketplace is run by the federal government to keep their subsidy and insurance.

The National Consumers League (NCL) applauds the Supreme Court for upholding the ACA subsidies for consumers using the federal marketplace. The Supreme Court decision helps prevent a rise in premiums for all consumers using the health care exchange. The subsidies are a key provision of the law and they are an important part of keeping consumers insured and healthy. This decision provides hope that the ACA will face fewer political and legal obstacles in the future and can continue to provide health insurance to consumers. Despite the naysayers, the numbers speak volumes. Since the ACA’s enactment, more than 16 million Americans have been able to afford quality health insurance they did not have before.

If you do not already have health insurance, you can enroll in person, over the phone, by mail, online at Healthcare.gov, or on your state exchange’s site during the open enrollment period.