Nebraska laws to protect patients and healthcare providers against unfair prescription insurance practices

Feb 17 2010

Dozens of patients and state and national advocacy and healthcare groups, including Nebraska Medical Association and Nebraska Nurses Association, today urged passage of two precedent-setting consumer protection healthcare bills during a hearing at the Nebraska State Capitol.  These laws would be the first in the nation to protect patients and healthcare providers against unfair prescription insurance practices.  

At the rally, a retired nurse tells of paying $10,000 out-of-pocket one year for a single medication -- despite having insurance.  A father tells of a son with hemophilia whose co-pays rose from $35 to more than $100, a price he struggles to afford. Meanwhile, physicians expressed outrage that insurers routinely "play doctor" by sending patients letters that not only deny prescription coverage, but challenge the necessity of the drugs they know are most effective.  

"These Nebraskans are not alone," says Sen. Abbie Cornett, who introduced LB 1017 and LB 1088. "Nebraska is on the leading edge of healthcare reform, yet we have a long way to go to ensure that patients get the coverage they've paid for and that their physicians are not second-guessed when it comes to prescribed medications."

LB 1017 takes aim at restrictive insurance co-payments by requiring all health policies in the state to include reasonable prescription drug benefits and limit the amount patients have to pay out-of-pocket for prescriptions. LB 1088 addresses the practice of patients being encouraged to switch to prescriptions that are similar to -- but not the therapeutic equivalent of -- the prescriptions their healthcare providers ordered. Known as therapeutic substitution, the practice takes patients off medicines that work well for them and switches them to different medications that are less expensive, but not necessarily as safe or effective.  For many patients, no medically equivalent substitutes exist so they are forced to pay full price for their prescriptions at a cost of hundreds to thousands of dollars a month or go without.  

"People buy insurance to be protected from financial hardship should they become ill," says Alliance for Plasma Therapies Executive Director Michelle Vogel. "Yet when a serious illness strikes, subscribers often are singled out for much higher out-of-pocket costs or are outright denied the medications their doctors' prescribed. Enactment of these bills will help end these unfair practices."