October 26, 2009
BLEEDING DISORDER LEGISLATION
By: John Kasprak, Senior Attorney
You asked if Connecticut has implemented a standard of care for people with bleeding disorders such as that found in a Pennsylvania legislative proposal.
Connecticut has not implemented a standard of care for bleeding disorders as proposed in Pennsylvania. The Pennsylvania bill has passed its House of Representatives and is currently before the Senate. New Jersey is the only state that has mandated standards of care for people with bleeding disorders.
On August 5, 2009, the Pennsylvania House of Representatives unanimously passed H.B. 620, the “Hemophilia Standards of Care Act.” The bill was then referred to the Pennsylvania Senate Public Health and Welfare Committee where it awaits action. Under the bill, health insurance policies, contracts, or managed care plans issued by all health insurers must provide benefits and health care services for patients with severe bleeding disorders. The state's Medicaid program is not subject to these provisions under the bill. A health insurer must provide coverage for services outlined in the bill provided to patients with bleeding disorders by a state-recognized hemophilia program.
The bill requires health insurers to contract with pharmacies to provide blood clotting products as prescribed by a treating physician. Also, a pharmacy must supply enough ancillary infusion equipment to prepare and infuse the quantity of the blood clotting product being dispensed. An insurer must also provide a covered person with a choice of at least three full-service home care pharmacies. All FDA-approved blood clotting products must be included in the insurer's formulary, if applicable. If an insurer requires preapproval or preauthorization of a prescription, it must be completed within 24 hours or one business day, unless the physician deems the circumstances urgent.
Finally, the bill requires an OB-GYN to request a medical screening for von Willebrand disease and other bleeding disorders before advising an individual that an invasive uterine surgical procedure is the most appropriate treatment for menorrhagia (heavy menstrual bleeding). A health insurer must provide coverage for this screening.
CONNECTICUT AND OTHER STATES
Connecticut has not enacted legislation similar to the Pennsylvania proposal. State law does set the maximum that the state will pay for Factor VIII pharmaceuticals (drugs used to treat Hemophilia A) in the Medicaid, State-Administered General Assistance, and ConnPACE programs. The law permits the Department of Social Services commissioner to designate specific suppliers from which pharmacists must order these drugs (CGS § 17b-491b).
To date, New Jersey is the only state with mandated standards of care for people with bleeding disorders. Similar proposals were introduced in 2009 in several states including California, Connecticut, Missouri, Minnesota, and Massachusetts, according to the National Hemophilia Foundation. The Connecticut bill, Proposed Bill 6283, was referred to the Public Health Committee but did not receive a public hearing.