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Helpful Resources: Learn More About The Issues

Health Benefit Design 101

Copay Accumulators / Maximizers

Copay Accumulators / Maximizers

View April 24, 2024 Lunch & Learn presentation on Health Benefit Design by Charles Miller, Senior Policy Advisor, Texas 2036.

Download Charles Miller's Lunch & Learn presentation: Health Benefit Design 101.

How large employers influence health benefits design and coverage

The Impact of Vertical Integration on Health Benefits Design and Delivery

Copay Accumulators / Maximizers

Copay Accumulators / Maximizers

Copay Accumulators / Maximizers

View October 29, 2024 Lunch & Learn discussion about copay accumulators, copay maximizers and other cost-shifting schemes that hurt Texans

Understanding Accumulators and Maximizers

Patients are caught in the middle

The Impact of Copay Accumulator or Maximizer Programs on Patient Costs and Health Outcomes

2024 Copay Accumulator Programs by State

Comparison of Premiums In States With and Without Copay Accumulator Bans

Copay Accumulators Increase Patient Costs

Medication Switching

Copay Accumulators / Maximizers

Medication Switching

View August 27, 2024 Lunch & Learn discussion on the impact of Non-Medical Switching on Texans with Mental Health Issues, led by Greg Hansch, Executive Director of NAMI-Texas.

What is Non-Medical Switching?

Switching a patient's coverage without consulting the patient or their physician is irresponsible

Understanding Non-Medical Switching

Position Statement on Non-Medical Switching

Prior Authorizations

Medication Switching

View the Sept 24, 2024 discussion about the prior authorization landscape by Austin oncologist Debra Patt, MD and Ben Wright of the Texas Medical Association.

2021 Texas "Gold Card" Law is Improving Prior Authorization Burdens, but More Work Remains

Texas "Gold Card" Prior Authorization Fact Sheet

Insurers' Prior Authorization Requirements Often Block or Delay Needed Medications and Services

Essential Health Benefits

Categorizing specialty medications as "non-essential health benefits" violates the law

Close the EHB Loophole to Ensure Patient Access to Lifesaving Medications

EHB Loophole Allows Insurers and PBMs to Exploit Patient Assistance Programs

Step Therapy

2017 Insurance Laws Benefit Texas Patients

Learn about the 2017 Texas step therapy reform law and the path to appeal insurers' requirements

Texas Step Therapy Law Fact Sheet

Pharmacy Benefit Managers

Pharmacy Benefit Managers

Pharmacy Benefit Managers

View May 22, 2024 Lunch & Learn with a "peek inside the black box" to gain a better understanding of PBMs and the complexities of what happens in the world of prescription drugs, led by Texas Pharmacy Association CEO Debbie Garza.

New York Times: PBMs drive up drug costs for millions of people, employers and the government (June 21, 2024 -- subscription required)

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