Policy Issues

Rising Cost of Prescription Drugs

Prescription drug costs continue to be a major driver of health insurance costs. While the huge spikes in the cost of some drugs, like the EpiPen, are well known, drug costs continue to rise due to extremely high initial pricing, unpredictable price hikes, and efforts to dissuade the use of more cost-efficient, quality alternatives such as generic medications.

NYSCOP supports measures aimed at addressing the impact drug costs are having on insurance premiums. These proposals include:

– Shedding light how much drug manufacturers spend on researching, developing, producing and distributing drugs compared to the billions of dollars spent on marketing, advertising, and promotional efforts such as co-pay coupons;
– Understanding how much profit drug companies are making on the various products; and
– Restoring tools that allow health plans to ensure consumers are using effective, affordable drugs to counteract aggressive marketing of unnecessary, high cost drugs.

View relevant documents:

– A Simple Truth: Prescription Drug Costs Are Too High
News Release | Infographic
– Curbing Opioid Abuse Starts With Educating Patients and Prescribers Of Risks
News Release | Infographic
– The Facts About Pharmacies and Prescription Drugs
– Prescriber Prevails for Medicaid Managed Care Legislative Memo
– Mail Order Pharmacy Legislative Memo

Protecting Consumers From Surprise, Out-of-Network Medical Bills

Consumers often choose their health insurance based on whether their doctor and preferred hospital are in the health insurance plan’s network. But when emergencies happen they go to the nearest hospital. Unfortunately, after receiving emergency treatment, consumers are frequently surprised by exorbitant medical bills.

That problem will be no more. On October 17, 2019, Governor Cuomo signed into law the bill designed to prohibit excessive hospital bills for emergency services and will protect New Yorkers from unnecessary premium increases.

Back in 2014, New York enacted a landmark law that protects consumers from surprise medical bills from doctors providing emergency services. The new law created an Independent Dispute Resolution (IDR) process to resolve disputed emergency charges from doctors who do not participate in their health insurance plan provider network. Unfortunately, a loophole in the law prevented these protections from being applied when the bill comes from the hospital instead of the doctor.

This latest bill closes the loophole in the original “surprise bill” law by including out-of-network hospitals in the IDR process. Consumers will be removed from the process and will feel protected knowing that the fees charged by hospitals are subject to an independent third party. The law goes into effect January 1, 2020.

View relevant documents:

– NYSCOP Statement
– Governor Cuomo Statement
– IDR Coalition Memo in Support
– 2019-20 Bill Text
– NYSCOP Memo in Support
– AARP Memo in Support
– Business Council of New York State Memo in Support
– Health Care For All New York Memo in Support
– Consumers Union Letter of Support
– Center for Medical Consumers Memo in Support
– Variation in Emergency Department vs Internal Medicine Excess Charges in the United States, JAMA

To find out more about the 2014 Surprise, Out-of-Network Medical Bills law, click here.