Governor’s Signature Reins in Medication Costs for Serious Health Conditions

Specialty tier prescription drug coverage bill becomes law

IMG_9370Wilmington, DE – Legislation signed today by Governor Jack Markell places limits on the costs to Delawareans’ for prescription drugs that treat many major health problems.  The final provisions of the law reflected hard work by many different groups within the health care community, who the Governor thanked for coming together to protect the affordability of these medicines. In addition to the Delaware Health Care Commission, which researched the effects of pricing on patient access and care, other groups and organizations involved included the National Hemophilia Foundation, Arthritis Foundation Mid-Atlantic Region, National MS Society – Delaware Chapter, Limestone Medical, Medical Society of Delaware, HIV Consortium, Pfizer and Highmark Blue Cross Blue Shield of Delaware. Many representatives from these groups joined the Governor in his office for the bill signing ceremony.

By restraining co-insurance and co-payment fees for specialty tier medications, Senate Bill 35 can drastically reduce the amount that patients will be expected to spend to receive the specialized, and consequently quite-expensive, medications that are necessary for the treatment of their serious long-term health conditions.

“Many of us know someone who is suffering from serious long-term health conditions such as hemophilia, HIV, hepatitis, multiple sclerosis, and lupus, and we are aware of the high personal expense associated with receiving treatment for such conditions,” said Governor Markell. “For Delawareans who are facing challenges like these, this bill will ensure they will not be unfairly denied access to prescription drugs because of increasing costs, and that in purchasing these life enabling medications neither they, nor their families will be forced to endure severe financial strain.”

Under the law a patient’s co-insurance or co-payment fees for specialty tier drugs will be limited to $150 per month for up to a 30-day supply of any single specialty tier drug. Patients will also be able to request an exception to obtain a specialty drug that would not otherwise be available on a health plan formulary. The bill goes into effect on January 1, 2014.

“This is helping make health care affordable for people by containing the cost of specialty drugs. Those drugs could cost thousands of dollars a month and those costs hurt families and could force people from their homes,” said Senate Majority Whip Margaret Rose Henry, D-Wilmington East, who sponsored SB 35 and led the fight for the law. “With this law, we are making the costs more affordable and helping people not only live longer, but to have better quality of life.”

Rep. Helene Keeley, a prime House sponsor of SB 35 and a board members of AIDS Delaware, said that many residents cannot afford escalating co-pays for prescriptions, which can lead to some not getting the medication they need to combat serious viruses and diseases.

“No Delawarean who has HIV, multiple sclerosis or cancer should be priced out of receiving the life-saving prescriptions they need to recover or simply survive,” said Rep. Keeley, D-Wilmington South. “By limiting the amount that patients can be charged for these specialty tier drugs, we are making it easier for them to access this medication and receive the treatment they need.”

Photos from the bill signing are available on Flickr.


Delaware Receives $2.48 Million Innovation Grant from Center for Medicare and Medicaid Innovation

(Dover, DE)   The National Centers for Medicare and Medicaid Services at the U. S. Department of Health and Human Services announced today that over the next six months, the state of Delaware will receive up to $2.485 million to develop its State Health Care Innovation Plan.

Delaware’s proposal entitled, “Transforming Delaware’s Health: A Model for State Health Care System Innovation,” addresses the need for a broad vision and comprehensive approach to more cost effective delivery of quality health care for all Delawareans.  Delaware plans to build a strong local foundation for innovation in order to develop a system-level transformative healthcare plan that can serve as a model for the country.  Through the collaborative planning process, Delaware will design a model to accelerate the adoption of payment and service delivery models across public and private payers; enhance health data collection and analytic capacity to support care coordination and outcomes-based payment models and integrate workforce planning, behavioral health and public health initiatives.

“Delaware will use the grant to develop a model system focused on better health, better health care and lower costs,” said Governor Markell.  “This is about meeting the health care needs of existing and coming generations and accelerating critical reforms that can deliver better health outcomes, better health care, and serve as a model for the nation.”

Governor Markell wrote a letter in September 2012, submitting the grant application for review.

“The award of this State Innovation Model Award to Delaware presents a tremendous opportunity at a critical time in health care. This award enables Delaware to develop innovative new models to deliver and pay for high quality affordable health care,” said Bettina Tweardy Riveros, Chair of the Delaware Health Care Commission and Advisor to Governor.  “ We appreciate the commitment of our entire health care community to work together to develop a statewide innovation plan and models that will improve health, improve health care and lower costs for all Delawareans.”

Details of the grant announcement can be found here.

Governor Markell & DHSS join DE’s Congressional Delegation to announce grant to support health insurance marketplaces

WILMINGTON – Today, Delaware Governor Jack Markell, Delaware Department of Health and Social Services (DHSS) Secretary Rita Landgraf, along with Delaware’s Congressional Delegation of U.S. Sens. Tom Carper and Chris Coons and U.S. Representative John Carney (all D-Del.) announced a $8,536,543 Exchange Establishment Grant award from the U.S. Department of Health and Human Services to the Delaware Department of Health and Social Services.

DHSS will use this grant to support the review of qualified health plan applications and to analyze additional policy options for ensuring continuity of care and coverage for lower income Delawareans.  The project will also support the implementation of the Marketplace Assister program and outreach and education campaign, as well as monitoring of federally-selected Navigators. With approximately 100,000 Delawareans currently uninsured, the expansion of Medicaid and the availability of subsidized commercial health insurance through the Exchange should provide many of those who are currently uninsured with access to affordable health coverage.

“This is an essential step in supporting our efforts to implement the Affordable Care Act,” Governor Jack Markell said.  “Delaware’s State Partnership Health Insurance Exchange will allow us to address the needs of health care consumers, including small businesses, and providers in a fiscally responsible way as we work together to ensure access to quality affordable health care for uninsured Delawareans. We appreciate the continued support from the U.S. Department of Health and Human Services and the Delaware congressional delegation in securing this grant.”

“This grant will allow us to build the infrastructure for the Exchange so we can begin enrolling uninsured Delawareans in October,” DHSS Secretary Rita Landgraf said. “Providing that access is one of the key goals of the Affordable Care Act. With this grant, we will be able to reach out to the 35,000 consumers who we expect to participate in the insurance marketplace, and also allow a seamless integration with our existing Medicaid program.”

Because of the Affordable Care Act, consumers and small businesses will have access to marketplaces starting in 2014. The marketplaces are one-stop shops that will provide access to quality, affordable private health insurance choices similar to those offered to members of Congress.  Consumers in every state will be able to buy insurance from qualified health plans directly through these marketplaces and may be eligible for tax credits to help pay for their health insurance.  These marketplaces promote competition among insurance providers and offer consumers more choices.

“As a result of the Affordable Care Act, individuals and small businesses in Delaware will gain the same purchasing power as large companies, and be able to compare, shop for, and choose insurance plans in an online marketplace that best meets both their health and financial needs,” said Sen. Carper. “By moving toward a health insurance system that harnesses the power of market forces and competition to drive down costs, we lower costs for everyone and improve access to lifesaving health care. This grant award will help Delaware set up this marketplace so that ultimately Delawareans begin to see better health outcomes for less money.”

“The Exchange Establishment Grant marks a major step in expanding access to affordable health care to all Delawareans,” Sen. Coons said.  “Health insurance shouldn’t be one size fits all, and the Affordable Care Act empowers individuals and small businesses to make health insurance choices that are right for their needs. Health insurance reform is a central part of not only our economic recovery but of our long-term economic growth.”

“The health insurance exchanges are a critical step to ensuring every Delawarean has access to quality, affordable healthcare,” said Congressman Carney.  “These grants make it possible for individuals and small businesses in Delaware to connect with the plans that meet their needs.  Delaware has been a national leader in this process, and I look forward to thousands of Delawareans getting the care they deserve when these exchanges go live in 2014.”

In total, $1.5 billion in new Exchange Establishment Grants were awarded to California, Delaware, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon, and Vermont to ensure these states have the resources necessary to build a marketplace that meets the needs of their residents. Delaware, Iowa, Michigan, Minnesota, North Carolina, and Vermont received awards today for Level One Exchange Establishment Grants, which are one-year grants states will use to build marketplaces. A total of 49 states, the District of Columbia, and four territories have received grants to plan their marketplaces, and 34 states and the District of Columbia have received grants to build their marketplaces.

Delaware will begin enrolling clients in its health insurance exchange in October for coverage effective on Jan. 1, 2014. Through the State Departments of Health and Social Services and Insurance and the Delaware Health Care Commission, Delaware pursued a State Partnership Exchange instead of a state-based exchange because of Delaware’s small population and costs associated with a state-based exchange. Delaware expects to serve about 35,000 people through the Exchange. The state will retain control of plan management, including state requirements for qualified health plans, as well as the consumer assistance function.

To stay updated on Delaware’s exchange activities, visit the Delaware Health Care Commission website at

For more information on the Health Insurance Marketplace, visit