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Reimbursement Legislation |
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By John S. James
AIDS Treatment News
This bill, AB 1722, has passed the California Assembly and been sent to the Senate. Recently it has turned out that the bill might not be needed in California--yet it illustrates a national issue. On August 17 we talked with a consultant in the office of the bill's sponsor, Assembly Member Gallegos. Their office just met with the new California Department of Managed Care, which has taken a fresh look at existing law, and interpreted it in a way more favorable to patients than the Department of Corporations, which had jurisdiction in the past. Since the new interpretation should be better than AB 1722 would have been, Gallegos might not "move" the bill in the Senate. But the issue is a national one, so to explain it we quote from an action alert, which was sent by the Lambda Letters Project:
Comment We are hearing about this problem elsewhere; it is likely that Federal or other state legislation will be necessary. Also, health insurance and managed care companies are using unworkable "caps" when they can no longer discriminate directly against patients with expensive illnesses. AB 1722 itself should not be a national model, because it excludes off-label use of medications (prescription for an FDA-approved medicine, but for a purpose different from that for which it was approved). Off-label prescription is often a necessary part of the standard of care (especially in cancer, for example, where many drugs officially approved for treating one kind of tumor, or several kinds, may in fact be standard treatment for other cancers as well). Insurance companies should not be able to use this excuse to nullify their medication coverage for persons who are seriously ill. A copy of A.B. 1722 is available at: info.sen.ca.gov/pub/bill/ asm/ab_1701-1750/ab_1722_bill_20000413_amended_asm.html AIDS Treatment News Published twice monthly Subscription and Editorial Office: P.O. Box 411256 San Francisco, CA 94141 800/TREAT-1-2 toll-free U.S. and Canada 415/255-0588 regular office number Fax: 415/255-4659 E-mail: aidsnews@aidsnews.org
Editor and Publisher: John S. James Associate Editor: Tadd T. Tobias Reader Services: Tom Fontaine and Denny Smith Operations Manager: Danalan Richard Copeland Statement of Purpose: AIDS Treatment News reports on experimental and standard treatments, especially those available now. We interview physicians, scientists, other health professionals, and persons with AIDS or HIV; we also collect information from meetings and conferences, medical journals, and computer databases. Long-term survivors have usually tried many different treatments, and found combinations which work for them. AIDS Treatment News does not recommend particular therapies, but seeks to increase the options available. Subscription Information: Call 800/TREAT-1-2 Businesses, Institutions, Professionals: $270/year. Includes early delivery of an extra copy by email. Nonprofit organizations: $135/year. Includes early delivery of an extra copy by email. Individuals: $120/year, or $70 for six months. Special discount for persons with financial difficulties: $54/year, or $30 for six months. If you cannot afford a subscription, please write or call. Outside North, Central, or South America, add air mail postage: $20/year, $10 for six months. Back issues available. Fax subscriptions, bulk rates, and multiple subscriptions are available; contact our office for details. Please send U.S. funds: personal check or bank draft, international postal money order, or travelers checks. ISSN # 1052-4207 Copyright 2000 by John S. James. |
A national problem with health insurance is illustrated by a
California bill to prevent companies from raising drug
deductibles and co-payments during the course of a patient's
illness.
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