The Maryland Psychiatric Society (MPS) serves as the voice of psychiatry for Maryland’s general public, provider and consumer organizations and the Maryland General Assembly. Through its advocacy, the MPS educates the public about mental health policy, psychiatry and successful treatment options. MPS advocacy initiatives below encompass the legislative/regulatory, political, psychiatric practice and communications arenas. Click here for more MPS advocacy news.
Copay Accumulator Reform: The MPS, along with many other Maryland organizations signed onto a letter last month regarding the need for copay accumulator reform in Maryland. The practice of using, “copay accumulator adjustment programs,” prevents any copayment assistance available to help patients pay for high-cost drugs from counting towards a member’s deductible or maximum out-of-pocket requirements. Although health plans often use different terminology or slightly variable practices, all pose significant threats to the communities we represent. Copay accumulator adjustment programs result in patients being left with very high out-of-pocket expenses to access their necessary medications. They are being used despite insurers and pharmacy benefit managers implementing utilization management (UM) protocols, such as prior authorization and step therapy, to ensure patients attempt lower-cost treatment alternatives first. This means that patients who have abided by and cleared the UM protocols in the plan design then confront the challenge of paying for the high out-of-pocket medications prescribed by their provider. The federal Notice of Benefit and Payment Parameters (NBPP) for 2021 made it clear that it is the responsibility of individual states to regulate copay accumulator adjustment programs. Fourteen states and Puerto Rico have banned copay accumulator adjustment programs. The letter was sent to key Maryland legislators. Click here to view a copy of the letter.
Preserve Telehealth Act of 2021: The new Preserve Telehealth includes several provisions that relate directly to the use of telehealth to satisfy network adequacy requirements and, in our view, guide and set the parameters of the Maryland Insurance Administration’s (MIA) regulatory options for the next two years. MPS signed onto a letter addressing several areas of concern with the network adequacy standards and the recently-enacted Preserve Telehealth Act of 2021.
Recommendations for Improving Maryland’s Public Behavioral Health System of Care were submitted to the MDH Workgroup in November 2019 and again in April 2021 to help guide changes in the public sector.
Children’s Behavioral Health Coalition Recommendations To The Kirwan Commission
The MPS asked the Maryland Congressional Delegation to direct CMS officials to instruct Maryland officials to mirror other state policies allowing Ordering, Referring, and Prescribing providers to arrange private pay arrangements with Medicaid patients, whose prescriptions and labs will continue to be paid by Medicaid.