(TRENTON) – Legislation sponsored by
Assembly Democrats Gary Schaer, Pamela Lampitt, Thomas P. Giblin and Gabriela
Mosquera to require health insurance providers to cover early refills of
prescription eye drops under certain circumstances was approved Monday by the
full Assembly.
“Anyone who has used eye drops knows
how easy it is to miss or have more than one drop fall from the bottle.
Punishing patients who rely on prescription drops to treat diseases like
glaucoma for this inevitability is unfair and puts their well-being at risk,”
said Schaer (D-Bergen/Passaic). “This bill helps ensure that people do not skip
taking critical prescription eye drops simply because they spilled or lost some
of their eye drops and were not allowed by their insurer to get an early
refill.”
The bill (A-3080) requires, in
certain circumstances, that health insurers that provide coverage for
prescription eye drops provide coverage for expenses incurred for a refill of
prescription eye drops in accordance with Guidance for Early Refill Edits on
Topical Ophthalmic Products provided to Medicare Part D plan sponsors by the
Centers for Medicare and Medicaid Services (CMS).
The CMS issued guidance on topical
ophthalmics to prevent the unintended interruption of drug therapy in situations
where patients legitimately need earlier refills of prescription eye drops.
While the guidance acknowledges that health insurers monitor appropriate refill
periods as part of utilization management, it also recognizes that
self-administration of drops may involve some reasonable amount of waste and
that earlier refills may be appropriate in some circumstances.
The requirement to provide this
coverage is conditioned on two factors: (1) the prescribing health care
practitioner indicates on the original prescription that additional quantities
of the prescription eye drops are needed; and (2) the refill requested does not
exceed the number of additional quantities indicated on the original
prescription by the prescribing health care practitioner.
“The refill limits imposed by
insurance providers leave no room for error which is unfair to patients who
depend on this medicine to treat serious eye problems,” said Lampitt
(D-Camden/Burlington). “The bill won't let patients get any more medicine then
their prescription allows, it simply allows them to get the next refill sooner
when they actually need it.”
“These quantity restrictions can be
difficult to meet. It’s not about being wasteful, it’s about being human,” said
Giblin (D-Essex/Passaic). “Individuals who rely on prescription eye drops to
treat certain diseases should have the peace of mind that their refills will be
covered if their drops run out before their insurance company says they
should.”
“Individuals who use prescription eye
drops to treat diseases like glaucoma can’t risk missing even a couple of days
of medicine,” said Mosquera (D-Camden/Gloucester). “They should not have to go
without important medicine because their usage on occasion did not meet the
timeline set by their insurance company.”
The bill was approved 69-7 by the
Assembly on Monday and now awaits further consideration by the Senate.
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