Maryland patients, especially those with chronic conditions, rely on continued access to care to manage their symptoms and live healthy lives. The day-to-day management of chronic and complex conditions already places a significant burden on patients and their families, but some Maryland health insurers are making chronic disease management even more difficult by adopting policies that impede access to timely care.
We are pleased that Maryland lawmakers have taken positive steps this session to prioritize important reforms (Senate Bill 791 and House Bill 932) that will increase transparency and accountability in the processes used by insurers and their pharmacy benefit management company (PBM) partners. Additionally, we commend the Maryland Insurance Agency (MIA) for issuing enforcement guidelines to ensure insurers and PBMs cannot deny patients continued use of active medications.
These steps are crucial to ensuring patients receive timely care and reducing the unfair administrative burden these insurance plans impose on physicians, but the fight is not over yet.
Maryland continues to lag behind many states in protecting patients and physicians. While no one disputes that health care is expensive, many states have successfully implemented policies that significantly reduce costs for patients. One such policy is the elimination of copayment accumulation programs, which allow insurers to prohibit copayment assistance from counting toward patients’ deductibles and maximum payments, all of which leads to higher costs and less access for consumers.
Accumulating copayments mean patients end up paying the copayment twice, once from a copayment assistance program and once from their own pockets. 99% Because many of the copayment assistance programs are used to treat illnesses for which there are no generic equivalents, these programs have become a lifeline for patients with complex or chronic illnesses who cannot access generic alternatives to treat their symptoms.
To date, 19 other states and the District of Columbia have given patients this protection. The Maryland General Assembly considered a bill last session and failed to pass it, but a proposed bill came closer to passing this year than in past years.
In addition to reforming the policies used by insurers and PBMs, Maryland must also address larger challenges.
It’s well-known that insurance company payments to Maryland’s doctors, healthcare workers and medical facilities are among the worst in the nation. Low payments impact access to care on many levels. Recruitment becomes even more difficult as doctors and other healthcare workers can no longer afford to work in Maryland or leave their jobs altogether due to staffing shortages. The result is staffing shortages in all areas of healthcare, leading to delays for patients to get timely appointments and schedule necessary procedures.
Our nation already has an ongoing, growing shortage of primary care physicians (PCPs). Maryland’s current resident-to-PCP ratio is 12% lower than the national average. Projections show that Maryland will need 23% more primary care physicians by 2030.
Unfortunately, this is a trend that is common across all physician types. Maryland needs to get to the root of the problem and determine how to correct this downward trend, including by increasing choice and diversity within the insurer community.
Similarly, Maryland must continue to ensure adequate insurance networks. Several years ago, the Maryland General Assembly and the MIA prioritized the need for insurers to have broad networks, and for a time, they were successful in their efforts. Yet too often we hear stories of physician groups and other medical facilities being barred from participating in insurer networks for reasons that are never clearly explained, limiting access to care.
“Once again, I applaud Maryland lawmakers and regulators for the great strides they’ve made this year to protect patients and doctors from insurance barriers. The Legislature must continue this progress by addressing copayment accumulation programs and a broad range of other issues, like payment and access to insurance networks, to ensure patients can get the care they need and Maryland maintains a strong health care system into the future.”
