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Myeloma Advocacy Update - March 30, 2010
On Tuesday, March 23rd, the President signed into law the Patient Protection and Affordable Care Act which transforms significant portions of the health care environment and contains a number of reforms that will be extremely beneficial for myeloma patients.
03.30.10

Health Insurance Reform Signed Into Law

On Tuesday, March 23rd, the President signed into law the Patient Protection and Affordable Care Act which transforms significant portions of the health care environment and contains a number of reforms that will be extremely beneficial for myeloma patients. Once the underlying legislation became law, the House and the Senate passed the Health Care and Education Reconciliation Act (amendments to the health reform bill). All of the provisions outlined below will go a long way in improving the quality of life for all myeloma patients.

The first provision that benefits myeloma patients is a provision in the health reform bill that grants access to clinical trials. Health insurance plans will be required to provide coverage for routine costs associated with participation in clinical trials. This is a huge win for myeloma patients as many patients have had to decline participation in trials due to plans refusing to pay for the same costs they would reimburse for a patient that is going through non-clinical trial treatment.

Secondly, health reform closes the Medicare "donut hole." This is clearly something that is important to our patients that participate in the Medicare program. The bill provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 (Effective January 1, 2010). It also phases down gradually the beneficiary coinsurance rate in the Medicare Part D coverage gap from 100% to 25% by 2020.

For brand-name drugs, pharmaceutical manufacturers will provide a 50% discount on prescriptions filled in the Medicare Part D coverage gap beginning in 2011, in addition to federal subsidies of 25% of the brand-name drug cost by 2020 (phased in beginning in 2013). For generic drugs, manufacturers will provide federal subsidies of 75% of the generic drug cost by 2020 for prescriptions filled in the Medicare Part D coverage gap (phased in beginning in 2011). Finally, the bill will reduce the out-of pocket amount that qualifies an enrollee for catastrophic coverage.

Both the health reform bill and the reconciliation bill include provisions that eliminate annual and lifetime caps on insurance coverage. Lifetime and annual limits on private insurance pose a considerable problem for individuals with myeloma. Patients who exceed their annual or lifetime limits have to find other ways to pay for medical costs, such as paying more out of pocket, finding new insurance, or worse curtailing medical care.

Lifetime limits would be eliminated in all health insurance plans – both new and existing – six months after enactment. Annual limits would be restricted in new plans until 2014, after which they would be prohibited in all new and in existing group health insurance plans. The Reconciliation bill is a significant improvement over the Senate bill, which exempts grandfathered plans from these critical reforms.

Lastly, health reform also eliminates "pre-existing conditions" as a barrier to health care coverage. This year, children with pre-existing conditions can no longer be denied health insurance coverage. Beginning in 2014, pre-existing condition discrimination will become a thing of the past for everyone with health insurance including myeloma patients. Additionally, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool beginning this year.


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