ACCC recently shared a CANCER BUZZ podcast that featured Matt Devino, MPH, director of Cancer Care Delivery and Health Policy at ACCC and Dr. Rahul Seth, assistant professor of Medicine at the State University of New York Upstate Medical University and the Empire State Hematology & Oncology Society President. With the Federal Trade Commission’s (FTC’s) unanimous launch of a formal inquiry into the business practices of pharmacy benefit managers (PBMs), Devino and Dr. Seth discuss the potential impacts of this inquiry and why everyone’s voice on the cancer care team is so critical to advocacy efforts at the state and federal level.

It wasn’t until the FTC received more than 24,000 public comments—some of which came from ACCC and its Oncology State Society members—during its request for more information regarding harmful PBM practices that it launched the formal investigation. Like the example shared here, oncology professionals across the nation can be patients’ greatest advocates in demanding healthcare reform to improve patient outcomes and their healthcare experience. All of which is done with patients’ health and safety at the forefront. And groups like ACCC and its Oncology State Societies provide an avenue for these voices to be heard by state and federal legislatures.

Below, Dr. David Eagle—the Legislative Affairs and Patient Advocacy Chair at New York Cancer & Blood Specialists in Patchogue, New York—shares more on his advocacy work through his day-to-day role and membership with the Empire State Hematology & Oncology Society.

Advocacy Efforts in New York
By David Eagle, MD

Like many state legislatures, the New York State Legislature runs according to its own distinct rhythm. Each year, the State Assembly and State Senate are in session from early January to early June. Any legislation that is not considered by the end of June’s session is done for the year. Further, legislation that passes by both houses has until the end of the calendar year to be signed off or vetoed by the Governor. This usually leads to a flurry of activity in June, and 2022 was no different. 

As is typical, there was good news and bad news from the New York State Legislature. The good news included the passage of Assembly Bill 879, requiring that for the purposes of clinical peer review, peer-to-peer physicians be in the same specialty as the health care service or treatment they are reviewing. The need for this may seems blindingly obvious to those of us on medicine’s frontlines. Who would go to a dermatologist for a second opinion for open heart surgery? Nevertheless, insurance companies have been escalating this bad prior authorization practice for years, and New York’s legislation is certainly a welcome change. We—at the Empire State Hematology & Oncology Society (ESHOS)—will be urging Governor Kathy Hochul to sign it into law.

Unfortunately, New York’s “gold card” bill (Senate Bill S8299) did not pass. This bill would have exempted healthcare providers from prior authorization (PA) requirements for certain services for a defined period of time if they have a greater than 90 percent PA track record. Similar legislation has since been signed into law in Texas and is under consideration in many other states. ESHOS hopes that this valuable bill is reintroduced next year and will do all that we can to support it. 

Also unfortunate this year was the passage of Assembly Bill A6770, which expands the types of awardable damages to those for whose benefit an action for wrongful death is brought. If signed by the Governor, this can be expected to increase New York’s already severely elevated medical liability premiums.

From Bill To Law

After a bill passes the New York State Legislature, the hard work for patient advocates begins. Last year, the Legislature passed Senate Bill S3762—a broad and sweeping bill that regulates PBMs on the state level. Bill provisions include the establishment of a PBM duty to cover individuals and providers and the need for PBMs to be licensed to practice in New York. Inappropriate PBM practices could result in revocation of their license.

Similar legislation was vetoed by the state’s former Governor in 2020, and there was no guarantee that Governor Hochul was willing to sign this new bill. To advocate for the signing of this bill, New York Cancer & Blood Specialists held a call with the Governor’s staff at the end of last year to encourage her to sign. The practice subsequently worked with a law firm to prepare a special report for the Governor’s office regarding legal challenges to PBM regulations in other states. ESHOS was thrilled when the Governor signed this legislation on December 31, 2021, leading to the establishment of the Pharmacy Benefits Bureau within the New York Department of Financial Services.

Just recently, ESHOS hosted a call with the leadership of this newly formed bureau. They are now in the process of rulemaking that will soon be available for public comment. We are impressed that the bureau is planning adequate staffing for its enforcement capabilities, and it is important for oncology practices and programs in New York to understand this new entity and its role in enforcing good PBM practices.  When PBMs in New York demonstrate conduct that is harmful and/or unfair to patients and practices, this bureau will be the place to go for comment or query. Though the bureau’s specific rules and regulations are forthcoming, it appears likely that the state of New York will lead the nation in finally ending some abusive PBM practices.

Learn more about ACCC’s advocacy efforts, including PBM and prior authorization reform, on its website and visit your Oncology State Society website to read about the efforts taking place in your state.