2013 -- H 5983 SUBSTITUTE A

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LC02317/SUB A

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2013

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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: Representative Thomas Winfield

     Date Introduced: April 11, 2013

     Referred To: House Health, Education & Welfare

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

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

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respectively by 2020; and

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

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

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

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

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

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

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result of glaucoma;

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

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glaucoma;

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

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after surgeries, and to relieve conjunctivitis and dry eyes;

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

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

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diseases;

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

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

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

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

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

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and

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

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

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

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including our most vulnerable populations;

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

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

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

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

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

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

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31, 2011; now therefore be it

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

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

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

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

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

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

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

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Physicians and Surgeons, and the Rhode Island Medical Society.

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LC02317/SUB A

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