Message from the CMS President

Legislative Harvest

LOOKING AHEAD to the midterms, we know that healthcare has been a rallying point in recent elections. It could be a decisive issue in November. Regardless of what happens at the federal level, your Chicago Medical Society took the lead by advancing reforms locally.

As health plan networks shrunk, we made sure plans sold in Illinois meet basic minimum standards. We laid out provisions of a bill that went on to become the Network Adequacy and Transparency Act. The legislation was enacted in 2017. As a result, plans sold in Illinois must ensure adequate networks of physicians; notify patients when a provider is no longer in a network; and maintain up-to-date provider directories.

Your CMS also took on prescription drug price gouging. We’ve partnered with everyone from city aldermen to U.S. senators on transparency and accountability measures for drug companies and PBMs.

We’ve been active on other legislative priorities on behalf of patients such as:

• Preventing health plans from removing a drug from their formulary or changing its tier status once the drug has been approved for coverage to treat a medical condition during the plan year. The new law also streamlines the process by which physicians can certify medical necessity.
• Strengthening mental health parity. A new law prohibits all prior authorization and step-therapy requirements for treatment of substance use disorders. School districts can no longer discriminate against mental health and addiction coverage.
• Extending the period a patient can refill a prescription for a non-controlled substance from 12 months to 15 months.
• Preserving continuity by giving Medicaid managed care enrollees the option to stay with their primary care physician if the contract between their physician and health plan is terminated.
• Raising the purchase age for all tobacco products, including e-cigarettes, from 18 to 21. This national movement, called Tobacco 21, was adopted in Chicago as an ordinance, as well as in various other counties and cities and states. In spite of the groundswell movement, however, Governor Rauner vetoed the legislation.

This is only a partial recap of the past year’s legislative bounty. Next month, we’ll update you on advocacy to protect physician practice and reimbursement.

Pushback from special interest groups is typically the roadblock to bills moving forward. That’s why critical mass and physician unity are so important.

Will you be practicing in 2019? Now more than ever, a unified Chicago Medical Society must lead rather than react to the forces reshaping medicine and healthcare delivery.

Vemuri S. Murthy, MD
President, Chicago Medical Society