COMMONWEALTH OF PENNSYLVANIA HOUSE OF REPRESENTATIVES CONSUMER AFFAIRS COMMITTEE PUBLIC HEARING RYAN OFFICE BUILDING ROOM 205 HARRISBURG, PENNSYLVANIA TUESDAY, FEBRUARY 18, 2020 11:00 A.M. PRESENTATION ON HOUSE BILL 853 BEFORE: HONORABLE BRAD ROAE, MAJORITY CHAIRMAN HONORABLE ROBERT MATZIE, MINORITY CHAIRMAN HONORABLE DONNA OBERLANDER HONORABLE TODD STEPHENS HONORABLE TOM MEHAFFIE HONORABLE ED NEILSON HONORABLE TOMMY SANKEY HONORABLE ERIC NELSON HONORABLE TINA DAVIS HONORABLE PETER SCHWEYER HONORABLE TINA PICKETT HONORABLE FRANK FARRY 2 HOUSE COMMITTEE STAFF PRESENT: PHIL KIRCHNER MAJORITY EXECUTIVE DIRECTOR HEATHER RODGERS MAJORITY LEGISLATIVE ADMINISTRATIVE ASSISTANT II BETH ROSENTEL DEMOCRATIC EXECUTIVE DIRECTOR TIM SCOTT DEMOCRATIC SENIOR RESEARCH ANALYST * * * * * Pennsylvania House Of Representatives Commonwealth of Pennsylvania 3 INDEX TESTIFIERS * * * NAME PAGE DR. MARION MASS PRACTICING PHYSICIANS OF AMERICA......................6 ANGIE SANTIAGO LEAD FINANCIAL ADVOCATE, ONCOLOGY, THOMAS JEFFERSON UNIVERSITY HOSPITAL..................9 ROBERT MENTZER............................................13 SAMUEL MARSHALL INSURANCE FEDERATION OF PENNSYLVANIA.................17 ARIELLE CHORTANOFF INDEPENDENCE BLUE CROSS..............................19 MICHAEL YANTIS HIGHMARK.............................................24 DOUGLAS FURNESS CAPITAL BLUE CROSS...................................25 4 SUBMITTED WRITTEN TESTIMONY * * * Jessica K. Altman Kathleen A. Arntsen Mara Brough Scott Brunn Suzanna Masartis Donna Oberlander Tien Sydnor-Campbell (See submitted written testimony and handouts online.) 1 5 1 P R O C E E D I N G S 2 * * * 3 MAJORITY CHAIRMAN ROAE: Good morning, everyone. 4 Good morning, everyone. It is now 11:00 so I'm 5 going to call this hearing of the House Consumer Affairs 6 Committee to order. Today, as you all know, it's the 7 public hearing for House Bill 853. I'm not going to say 8 much here. I'm going to save as much time as I can for the 9 testifiers to testify, but we do have with us our Minority 10 Chair, Representative Matzie, if you'd like to say 11 anything. 12 MINORITY CHAIRMAN MATZIE: I echo your 13 sentiments. Look forward to the testimony. Thank you, Mr. 14 Chairman. 15 MAJORITY CHAIRMAN ROAE: All right. And then we 16 have the prime sponsor of the legislation, Representative 17 Donna Oberlander. If you'd like to briefly describe your 18 bill. 19 REPRESENTATIVE OBERLANDER: Yes, thank you, Mr. 20 Chairman. Thank you, Chairman Roae, and thank you Chairman 21 Matzie for the opportunity to address your committee today. 22 House Bill 853 is legislation that would amend 23 Pennsylvania's Unfair Insurance Practices Act to prohibit 24 health insurers from altering the coverage or premiums 25 included in an insured person's health insurance policy 6 1 during the policy term when an insured person has already 2 received a specific treatment, service, or prescription 3 drug. And I know that you have a full panel that will be 4 able to describe the situations that occur and I, again, 5 thank you very much for the opportunity to be here and to 6 hear more. Thank you. 7 MAJORITY CHAIRMAN ROAE: Okay. If our first 8 panel could start working their way up to the table, 9 please. We're going to have Dr. Marion Mass from 10 Practicing Physicians of America; Angie Santiago, Lead 11 Financial Advocate for Oncology at Thomas Jefferson 12 University Hospital; and Mr. Robert Mentzer. 13 So without any further ado, you may begin your 14 testimony. 15 DR. MASS: Okay, wonderful. Is that microphone 16 working? Terrific. 17 MAJORITY CHAIRMAN ROAE: It is. 18 DR. MASS: Thank you so much. 19 MAJORITY CHAIRMAN ROAE: When the green dot is 20 lit, we should be able to hear you. 21 DR. MASS: Okay, wonderful. 22 So Representative Oberlander, Representative 23 Matzie, and Representative Roae, I thank you and the entire 24 panel for having me here today to testify on behalf of 25 Pennsylvania patients. 7 1 Other than practicing as a pediatrician in Bucks 2 and Montgomery County of Pennsylvania, I have no conflict 3 of interest. I paid my own way to come here today as I do 4 for each and every advocacy trip that I take. 5 House Bill 853 is vital to protecting the health 6 and well-being of patients, especially those with serious 7 chronic medical conditions. Patients with chronic illness 8 and preexisting conditions deserve consistent benefits 9 during the tenure of their insurance plans. Thus, non- 10 medical switching during a plan year must end. 11 Let me start with a story. Ryan was diagnosed 12 with a complex partial seizures at age 17, and for most of 13 the last 20 years he has been well-controlled on Topamax 14 and Lamictal. Initially, he had excellent coverage for 15 brand names of both, but his out of pocket cost for the 16 brand name shot up suddenly and unexpectedly to $320 for a 17 three-month supply compared to $10 for the generic. Ryan 18 switched to generics three separate times during the middle 19 of the policy year. With two of the three switches, he 20 suffered breakthrough seizures. 21 For those listening who are unaware, having a 22 seizure not only is a life-threatening event while driving 23 a car or operating any mechanical or sharp implements, 24 breakthrough seizures prevent epilepsy sufferers from 25 driving for a period of time. Ryan also suffered 8 1 accentuated side effects of memory decline and dizziness 2 and intense worry of having a seizure at a dangerous time. 3 This affected both his personal and professional life. 4 Now, Ryan is a staunch advocate, a staunch self- 5 advocate. During the time of trying to advocate to get 6 back on brand name, he suffered the disruptive and very 7 frustrating process of having to make multiple calls per 8 week, lasting upwards of 30 minutes, to his insurance 9 company. 10 There are 133,000 epileptic patients in 11 Pennsylvania. There are 7.7 million patients in our 12 Commonwealth with at least one chronic disease and almost 13 half of those have more than one chronic disease, most 14 necessitating medication. Not all of those patients can 15 advocate as well as Ryan. Non-medical switching is 16 dangerous to their health and destructive to their well- 17 being as well as their pocketbooks. 18 I've seen dozens of affected children personally 19 and I am here to tell this committee and all of 20 Pennsylvania we must protect treatment decisions made 21 between physicians and the patients for whom they care so 22 that patients get the appropriate access that they deserve 23 at a reasonable, sustainable cost that is not causing them 24 to start rationing their medications. 25 During the questioning, I'm happy to reveal more 9 1 specifically what I know regarding drug pricing, formulary 2 switching, and pharmacy benefit managers. I've written a 3 good bit on them the lay press and I've given lectures on 4 them down in the U.S. Congress. I can share citations from 5 other states who have advanced legislation and some that 6 have studies regarding the dangerous practice of non- 7 medical switching, studies that are salient to this 8 discussion and I will have references available to you all 9 after this hearing is over. 10 For Pennsylvanians living with chronic health 11 conditions, coverage changes allowed by non-medical 12 switching can devastate health and finances. Coverage, 13 when purchased, must remain fair and consistent. After 14 all, patients cannot change their coverage mid-plan year. 15 Insurers should not be able to change formulary coverage 16 during the policy year for treatments and services that the 17 patient is receiving. That's just. 18 It's time for this committee and all policy 19 makers to put patients first. Just like you, I took an 20 oath. Mine was to protect patients. Let's roll up our 21 sleeves and do that together. Thank you. 22 MAJORITY CHAIRMAN ROAE: Thank you for your 23 testimony. 24 Go ahead, next. 25 MS. SANTIAGO: Hi. My name is Angie Santiago. 10 1 I'm the lead financial advocate at the Sidney Kimmel Cancer 2 Center at Jefferson University Hospital. Thank you for 3 scheduling this hearing and allowing me to share my 4 experiences with non-medical switching. 5 My job at the Sidney Kimmel Cancer Center is the 6 help patients understand what their health insurance covers 7 and to give them options for additional financial support 8 to help cover the cost of treatment such as copays, 9 foundations, and the hospital's charity care program. Our 10 cancer sees about 4,000 patients a year and we started 11 having problems with non-medical switching about a year- 12 and-a-half ago. 13 I'm not going to read this script. I'm going to 14 give you guys a live -- push it? It says green. 15 MAJORITY CHAIRMAN ROAE: Yeah, the light should 16 be green. 17 MS. SANTIAGO: It's green. 18 MAJORITY CHAIRMAN ROAE: Maybe get it closer to 19 your mouth maybe. Thank you. 20 MS. SANTIAGO: Okay, sorry. Is this okay? 21 MAJORITY CHAIRMAN ROAE: Yeah. 22 MS. SANTIAGO: Is this better? Okay. 23 So I'm going to give you guys a live example for 24 a patient which basically is going to summarize all this 25 stuff that they wrote up for me. 11 1 I had a patient who started treatment last April 2 2019 and his insurance allowed it at the time to be his 3 medical benefits. He was receiving one immunotherapy and 4 one bone injection. His medical benefits covered him at 5 100 percent; therefore, when he received treatment, no bill 6 could generate.