2013 -- S 0537 SUBSTITUTE A

=======

LC01311/SUB A

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

____________

J O I N T R E S O L U T I O N

RESPECTFULLY REQUESTING THE OFFICE OF THE HEALTH INSURANCE

COMMISSIONER TO ENSURE THAT RHODE ISLAND INSURERS COVER TOPICAL

OPHTHALMIC TREATMENT EARLY REFILLS IN A MANNER SIMILAR TO OR

CONSISTENT WITH CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)

GUIDELINES FOR ALL COVERED INDIVIDUALS

     

     

     Introduced By: Senators Felag, Lynch, Ciccone, Lombardi, and Ottiano

     Date Introduced: February 28, 2013

     Referred To: Senate Health & Human Services

1-1

     WHEREAS, According to the World Health Organization (WHO), there are an estimated

1-2

45 million persons with open angle glaucoma and this figure is projected to rise to 59 million

1-3

respectively by 2020; and

1-4

     WHEREAS The National Eye Institute estimates the prevalence of open angle glaucoma

1-5

in the U.S. population aged 40 and older at 1.86 percent;

1-6

     WHEREAS Increased risk factors for open angle glaucoma include age, family history,

1-7

national heritage (for example African American or Latino American heritage), having had

1-8

serious eye injury or eye surgery in the past, or the taking of a corticosteroid medication;

1-9

     WHEREAS, Early detection and treatment is critical to preventing serious vision loss as a

1-10

result of glaucoma;

1-11

     WHEREAS, Eye drops are often used in the treatment of certain chronic diseases such as

1-12

glaucoma;

1-13

     WHEREAS, Eye drops are also used to reduce the risk of infection, reduce inflammation

1-14

after surgeries, and to relieve conjunctivitis and dry eyes;

1-15

     WHEREAS, This General Assembly strongly supports early refill of prescription eye

1-16

drops necessary to ensure continued access to effective treatments for individuals with eye

1-17

diseases;

1-18

     WHEREAS, The Centers for Medicare & Medicaid Services (CMS) have issued

1-19

regulations that authorize refills, for inadvertent spillage at a rate of 70% in a 30 day time period,

2-1

allowing patients to refill at day 21 for the essential topical ophthalmic treatments; and

2-2

     WHEREAS, The major insurers in Rhode Island have provided written assurances that

2-3

their pharmacy policies allow for early refills similar to or consistent with the CMS regulations;

2-4

and

2-5

     WHEREAS, Health care professionals interested in ensuring proper dosage for treatment

2-6

of eye disease may work with pharmaceutical companies that manufacture and distribute

2-7

ophthalmic products to seek additional safeguards and allowances for spillage by patients,

2-8

including our most vulnerable populations;

2-9

     WHEREAS, Rhode Island healthcare providers and pharmacists may work together to

2-10

continue to inform patients about coverage for early refill of medication and proper usage as

2-11

prescribed and needed to ensure effective treatment and positive health outcomes; and

2-12

     WHEREAS, While the Patient Protection and Accountability Act (PPACA) allows states

2-13

to mandate health benefits for qualified health plans; however, effective January 1, 2014, the

2-14

PPACA will assess costs to the states for additional benefits that are mandated after December

2-15

31, 2011; now therefore be it

2-16

     RESOLVED, The General Assembly respectfully requests that the Office of the Health

2-17

Insurance Commissioner continues to ensure that Rhode Island insurers cover topical ophthalmic

2-18

treatment early refills in a manner similar to or consistent with the Centers for Medicare &

2-19

Medicaid Services regulations for all covered individuals; and be it further

2-20

     RESOLVED, That the Secretary of State be and is hereby authorized and directed to

2-21

transmit duly certified copies of this resolution to the Governor, the Director of the Department of

2-22

Health, the Office of the Health Insurance Commissioner, the Rhode Island Society of Eye

2-23

Physicians and Surgeons, and the Rhode Island Medical Society.

     

=======

LC01311/SUB A

========

     

S0537A