Senate Health and Welfare Committee and H. 766 - this week

The Senate Health and Welfare Committee plans to begin “mark up” (discussion and editing) of H. 766 this week.  H. 766 will reduce prior authorizations, allow exemptions to step therapy and simplify billing and other administrative burdens in health care.  Please start to contact members of the Senate Finance Committee this week to express support for the bill!  If you have previously contacted other committees, it is critical that the Finance Committee also hear your message – please send your comments to them.  If you are a constituent of a Finance Committee member, please consider calling.  Payers are stating this bill will increase insurance premiums.  Please share stories about how reducing PAs can actually reduce health care costs by getting patients the right care earlier, reducing extra costs like referring patients to the ED and reducing staffing costs. 

Please email the Finance Committee at: acummings@leg.state.vt.us; mmacdonald@leg.state.vt.us; cbray@leg.state.vt.us; rmccormack@leg.state.vt.us; rbrock@leg.state.vt.us; kramhinsdale@leg.state.vt.us; tchittenden@leg.state.vt.us; ZBuckminster@leg.state.vt.us.

 You can view the press conference last week supporting H. 766 here, press release, and media coverage here and here. 

In more detail, H. 766 as passed the House  would:

1. Require health plans to allow requests for exceptions to prescription drug step-therapy under specific conditions, like if a patient is stable on an existing therapy or if the drug is expected to be ineffective;
2. Mandate adherence to coding standards and guidelines for processing healthcare claims and prohibit prepayment claims edits (ending a burdensome Blue Cross Blue Shield of Vermont policy that requires prepayment review of certain claims, including those used with Modifier -25 and -59);
3. Limit claims edits for services other than pharmacy to those instances when Medicare uses claim edits;
4. Require health plans to limit prior authorization for procedures and imaging to the instances when Vermont Medicaid uses prior authorization;
5. Reduce the time frames for health plans to respond to prior authorization requests to 24 hours for urgent requests;
6. Limit the occasions for reauthorization of previously approved treatments and medications.