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Environment March 5, 2020

People Get Ready – Preparing for the Coronavirus in the Age of Trump

This blog post was updated March 11 to respond to the evolving policy landscape.

Over the last ten days, headlines have been dominated by the growing global spread of COVID-19 and its effect across the United States.  Readers who advocate on behalf of people living with HIV/AIDs would be justified in objecting to the appointment of Vice President Mike Pence to lead the Trump Administration’s response effort as a particularly ill-suited choice.  While Governor of Indiana, Pence’s ideological opposition to common sense preventive health measures exacerbated a localized HIV outbreak. A subsequent study concluded that an earlier, more proactive response from Indiana officials would have “substantially blunted” the outbreak, with the authors later concluding that “Pence’s handling of the Indiana HIV outbreak is a case study in mismanagement of a public health crisis.”  As with so much in this Administration, health care advocates feel like they have stepped through the looking glass as they watch the COVID-19 crisis unfold.  Such concerns lead directly to the question of what we can do in the meantime to prepare in the face of an inadequate governmental response.

Coronavirus Preparedness and Access to Prescription Medications.  As our understanding of COVID-19 and its potential impact in the United States continues to evolve, increased attention is being paid to preparedness. While there are many aspects to preparedness, one recommendation that is particularly relevant to people living with cancer, HIV, hepatitis C, diabetes, and other chronic illness is this: Make sure you have at least a 30-day supply of your prescription medications.

Having an available supply of medications helps ensure that access to essential regimens is not affected by potential disruptions in the health care system, and also helps alleviate potential stress on the health care system if situations worsen. Unfortunately, insurance policies can be a barrier to medication preparedness. For example, an insurance company may only authorize a refill of a prescription when a person’s previous supply has been nearly finished.

Importantly, some states have laws or other policies in place to support prescription preparedness in the event of a public health emergency. On March 1st, Florida Governor Ron Desantis issued an executive order declaring a state of emergency which, among other implications, means that health insurers, managed care organizations, and other entities licensed by the Florida Office of Insurance Regulation that provide prescription medication coverage must waive time restrictions on prescription medication refills.

Similarly, the Centers for Medicare and Medicaid Services (CMS) requires Medicare Part D (prescription drug) plans to lift “refill too soon” limits when a Presidential major disaster or emergency declaration is issued. As of March 4, 2020, President Trump has not issued a declaration that would trigger the requirement to take effect; however, CMS also encourages plans to lift limits in advance of an impending disaster. Please note: The Secretary of the Department of Health and Human Services can also declare a public health emergency that lifts “refill too soon” limits and triggers other requirements. A public health emergency, as declared by Secretary Azar, has been in place since January 27, 2020. CMS issued related guidance for Part D sponsors on March 10, 2020.

Advocates and other concerned persons can take the following steps right now towards prescription preparedness in the face of COVID-19:

– Review your state laws, regulation, and guidance documents to understand whether, and under what circumstances, insurance companies are required to ease refill restrictions. (CHLPI has initiated research on this issue for several states, which can be accessed here.) The link was removed given the quickly evolving landscape.

– If insurance companies are required to ease restrictions subject to the occurrence of a specific event (such as a declaration of emergency), advocate for government officials to take such necessary steps.

– In states that do not have requirements, advocate for regulators to release a bulletin encouraging insurance companies to support emergency preparedness.

– Call insurance companies to ask if they will waive refill restrictions to support preparedness.

Events such as COVID-19 and recent natural disasters highlight gaps in law and policy that increase the likelihood of poor health outcomes among vulnerable communities. CHLPI is working to ensure reforms that strengthen coordination and enable continuity of care.

About CHLPI’s Emergency/Disaster Preparedness Project:
In 2019, CancerCare, a leading national nonprofit providing free, professional support services to individuals affected by cancer, launched a project to identify and begin to address the challenges cancer patients face in the wake of a natural disaster. CHLPI is working with CancerCare to provide policy guidance and support for the disaster response program.  

CancerCare’s initiative is funded by the Bristol-Myers Squibb Foundation and the Merck Foundation.

The current crisis highlights another important effect of our work.  Advocates for access to health care generally believe that universal health insurance coverage is essential.  The COVID-19 outbreak underscores an important but underappreciated aspect of universal coverage.  Access to care amidst a pandemic benefits not only the people who are themselves covered, but also mitigates the effect of the virus across the entire U.S. population. When Medicaid beneficiaries are guaranteed COVID-19 testing without a co-pay, for example, the beneficial effects in disease mitigation will compound across all residents in a state.