During a recent trip to the pharmacy, Tampa resident Michael Ruppal was told his medication was no longer covered. He has another month until his annual health insurance contract is up for renewal or cancelation.
"There's a prescription that I've been on for at least four years with no problems. I've been with the same insurer for four years and I get to the pharmacy for the refill normal refill. It's no longer covered. It was just denied."
The pharmacist couldn’t help him, so he went home, called his insurance company, and was told he’d have to try another medication and “fail on it” before they’d consider covering his specific prescription again.
“I said, ‘Well, I've been on this for years’ and it took almost an hour and a half just with the insurance company and I still have to go back to my provider in person. And then the pharmacy again in order to get this drug that I've had forever. It was OK yesterday but it's not ok today.”
That same Thursday, the Florida Senate unanimously passed a bill (SB 182/HB 95) that prevents this exact situation from happening.
If signed into law, insurers could not change out of pocket prescription costs, create more restrictions, or remove coverage of them during a health plan year. It does not prevent health plans from being able to add brand and generic medications to their formularies or to make coverage changes if the FDA announces drug safety concerns or if there are medications removed from the market.
Michael Ruppal is also the director of the Tampa-based AIDS Institute, which leads Floridians for Reliable Health Coverage - a coalition of 39 patient and provider groups. They’ve been advocating the last four months for the "Bait and Switch" bill. Now Ruppal has firsthand experience with the practice. He has to take off work for another doctor visit, and pay the co-pay again.
“And this isn't a serious illness, so there are so many people out there that dealing with things that are life threatening, especially respiratory issues, that they can't afford to go back and try things that don't work for them. It could literally kill them.”
“And that's the concern we have, that this has been going on for years. So much of not only the public, but our institutions, just accept that the insurance companies have been doing it for years so we're just used to it. And I think that this is the time to draw the line.”
According to a recent Global Healthy Living Foundation survey of Floridians living with chronic conditions, 68 percent reported that their health insurer reduced coverage of the medication they were prescribed. Of these, nearly 75 percent were forced to switch to entirely different treatment, and as a result, 88 percent reported negative health consequences, nearly half missed work, and 19 percent were hospitalized.
“Many Florida families carefully choose a health plan that covers the medications they need at a price they can afford, but unfortunately, insurers can pull a bait-and-switch by altering prescription benefits at any time during the policy year,” said bill sponsor Sen. Debbie Mayfield in a news release. “The Bait and Switch Bill will ensure that Floridians have access to the benefits that were marketed and sold to them for the year. If a consumer can’t change their health plan in the middle of the year, insurers shouldn’t be able to either.”
The bill is currently awaiting action from the Health Innovation Subcommittee and has to pass the House before hitting the governor's desk.