Public Comments for 02/07/2024 Appropriations - Health and Human Resources Subcommittee
HB278 - State plan for medical assistance services; fertility preservation treatments, etc.
Good Afternoon, On behalf of the Virginia Association of Hematologists and Oncologists (VAHO) and the Association for Clinical Oncology (ASCO), I have attached a letter of support for HB 278.
My name is Michael Gordon. I am a recovering addict. My clean date is 06/06/2008. I writing this letter because it my duty as a health professional to bring to the table how important it is that we change the barrier crime law. I have spent countless hours and days working with other addicts who trying to find their pathway into recovery. The frontlines are thin because the people whom society deemed unworthy because of some past mistakes cannot work in the field that they could do the greatest good. I did not know when I received my sentence in 1990 for distribution of crack cocaine. I would be serving a life time sentence. Luck for me I don’t have a barrier crime, yet today after getting my GED, going to college and graduating with honors. I still can live in certain areas or have certain jobs. I went from the crack house to the White House and still that not enough for Virginia to forgive me of my past mistakes. We need more people who has made a deep commitment to change to share their experiences with others who are suffering!!
HB348 - Employment; paid sick leave, civil penalties.
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Hi I am writing to you on behalf of The Well Connection UK, a media and publishing company. We could easily get virginia.gov featured in various publications such as magazines, online blogs and news sites. This would undoubtedly help virginia.gov with publicity, reputation, domain authority and organic search engine rankings. We have a wide range of options including completely free collaborations, sponsored posts, guest posts and banner ads. If this sounds of interest, please reach out to the senior business development manager, Anita at info@thewellconnection.co.uk and whatsapp +447395206515 (GMT) Kind regards Clifton Junior Outreach Assistant
Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
I'm not sure which bill I'm commenting on entirely. All I know for sure is I'm a type 1 diabetic of 30 years. And our government seems to care very little about my health or the insane costs of the medication that I absolutely have to have to live. Or getting the care I need. Which has been expensive, and has kept me struggling to survive pay rent or see the many doctors I need to see. I am ready to share my story. About my lows where I wake up in the hospital then wind up with an $8000 hospital bill as well as a $4000 bill for a 10 minute ambulance ride. Or about my highs, or just about the struggle of being a Diabetic who was uninsured who struggles to survive in a government that seems to care more about pharmaceutical companies profits than it's citizens health. I have quite a bit to say on the subject and my struggles as a diabetic.
The Virginia NAACP strongly support hb 348 paid sick leave
The Virginia NAACP strongly support hb 348 paid sick leave
Please vote YES on this critical piece of legislation. We're just coming out of a particularly challenging respiratory virus season--we know that illnesses like flu, COVID-19, and RSV are not going away. 1.2 million working Virginians do not have paid sick days. That's 1.2 million Virginians who aren't able to rest, recover, or protect their coworkers from catching illness if they're sick. This is not just a humane or ethical bill; it's one that makes business sense. Employers lose $160 billion annually in productivity due to workers coming to work despite illness or injury. This bill would make a huge difference in the lives of working Virginians attempting to keep themselves and their families healthy. Please vote yes!
Vote YES on HB348 to give all workers paid sick days. Not having paid sick days means that workers have to choose between paying rent and taking care of themselves or their family members, and that choice is not fair to them or to the rest of society. This is a personal health issue (people can't care for themselves or their children or families) and a public health issue. More than half of all Norovirus outbreaks can be traced back to sick food service workers who were forced to choose between working sick and losing pay or their job. I personally know multiple food service workers who don't want to go to work sick because they know the risks of spreading disease, but they feel like they must because they need to buy groceries. It's also a financial issue. Without paid sick days, workers go to work sick, infecting others and impacting productivity. Employers lose $160 billion annually in productivity due to workers coming to work despite illness or injury. Having paid sick days will also save money in lower healthcare costs.
Représentatives, My name is Amber Pearson and I am a member of United Campus Workers, and I support HB 348. If the pandemic has taught us nothing else, it is that we all suffer when people are forced to choose between their or their family's health and paying the bills. Please support this bill. Amber Pearson
STATEMENT OF FRED CODDING IRON WORKERS EMPLOYERS ASSOCIATION HOUSE LABOR AND COMMERCE - SUBCOMMITTEE #2 COMMITTEE JANUARY 25, 2024 I AM FRED CODDING OF 10382 MAIN STREET, FAIRFAX, VIRGINIA 22030. THIS STATEMENT IS SUBMITTED ON BEHALF OF THE IRON WORKERS EMPLOYERS ASSOCIATION (IWEA). WE WELCOME THE OPPORTUNITY TO EXPRESS CONSTRUCTION’S CONCERNS WITH HOUSE BILL 348 AND HOUSE BILL 737. THE IRON WORKERS EMPLOYERS ASSOCIATION (IWEA) CONTRACTORS WORK THROUGHOUT VIRGINIA. ITS CONTRACTOR MEMBERS, WHICH INCLUDE MINORITY CONTRACTORS, WORK ON SMALL AND LARGE PROJECTS. MEMBERS OF THE IRON WORKERS EMPLOYERS ASSOCIATION ITSELF SUPPLY AND INSTALL REINFORCING STEEL, STRUCTURAL STEEL, WINDOW WALL, CURTAINWALL AND RELATED PRODUCTS ON PROJECTS THROUGHOUT THE COMMONWEALTH. WE SHOULD POINT OUT THAT MANY OF OUR MEMBERS ARE SMALL BUSINESSES. OUR MEMBERS EMPLOY IRON WORKERS WHO ARE WORKING ON JOBS THROUGHOUT VIRGINIA AND NEIGHBORING JURISDICTIONS. THEY MAY BE ON A JOB HERE IN VIRGINIA, BUT TOMORROW MAY BE IN NORTH CAROLINA, TENNESSEE, WEST VIRGINIA, THE DISTRICT OF COLUMBIA, MARYLAND, PENNSYLVANIA OR DELAWARE. THEY TRAVEL EXTENSIVELY. IN ADDITION, THEY MOVE FROM ONE CONTRACTOR TO ANOTHER IN RELATIVELY SHORT PERIODS OF TIME. THIS IS AN INTEGRAL PART OF THE INDUSTRY. AS A RESULT, THEIR PAY LEVELS REFLECT MOBILITY. IN ADDITION, CONSTRUCTION CONTRACTORS FREQUENTLY PROVIDE COSTLY PENSIONS, HEALTH CARE, WORKERS COMPENSATION INSURANCE AND PREMIUM TIME ON A NUMBER OF HOLIDAYS AS WELL AS WEEKENDS. IN ADDITION, THEY PROVIDE DISABILITY INSURANCE. IN ADDITION TO THESE, OUR MEMBER CONTRACTORS ALSO CONTRIBUTE $1.55 PER IRON WORKER MANHOUR WORKED FOR CONTINUING TRAINING OF APPRENTICE AND UPGRADING PROGRAMS. THE BURDENS THE LEGISLATION PLACES ON CONSTRUCTION CONTRACTORS INCREASES THOSE THEY ALREADY BEAR. THE LEGISLATION SUBSTANTIALLY INCREASES RECORD-KEEPING REQUIREMENTS. NUMEROUS OTHER JURISDICTIONS HAVE RECOGNIZED THESE CONCERNS. IF A BILL PASSES, WE ASK THAT THE CONCERNS OF CONSTRUCTION BE ACCOMMODATED. WE REQUEST AN EXEMPTION FOR CONSTRUCTION. ABSENT A FULL EXEMPTION, WE REQUEST AN EXEMPTION FOR THOSE WITH COLLECTIVE BARGAINING AGREEMENTS. AS NOTED, THIS HAS BEEN DONE IN MANY OTHER MAJOR JURISDICTIONS.
HB385: there’s an importance and safety to having two man crews.. safety for the company and the public.
Nearly all workers will need to take time away to deal with a serious personal or family illness, or to care for a new child or an aging parent. These life stages shouldn’t mean economic insecurity for Virginia’s workforce. Providing access to paid sick days for Virginia’s workers would allow them to maintain economic security and ensure a healthier, more productive workforce in the Commonwealth. More than 80 percent of food industry workers and 75 percent of childcare workers have no paid sick days. Moreover, employers lose $160 billion annually in productivity due to “presenteeism” (the practice of coming to work despite illness or injury). Additionally, providing paid medical and family leave results in reduced turnover. Paid Sick Days Benefit Workers, Families, Businesses, Public Health & the Economy! When sick workers are able to stay home, the spread of disease slows, and workplaces are both healthier and more productive. Plus, workers recover faster from illness and obtain timely medical care –enabling them to get back to work sooner and holding down health care costs. Providing paid sick days would protect hard working families and level the playing field for small companies.
HB515 - State hospitals; discharge of individuals.
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Hi I am writing to you on behalf of The Well Connection UK, a media and publishing company. We could easily get virginia.gov featured in various publications such as magazines, online blogs and news sites. This would undoubtedly help virginia.gov with publicity, reputation, domain authority and organic search engine rankings. We have a wide range of options including completely free collaborations, sponsored posts, guest posts and banner ads. If this sounds of interest, please reach out to the senior business development manager, Anita at info@thewellconnection.co.uk and whatsapp +447395206515 (GMT) Kind regards Clifton Junior Outreach Assistant
Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
I am a legal guardian and the President of CVTC Families and Friends . I oppose HB515 as written, although Delegate Hope's Legislative Aide has informed me that there will be an amended version. The unamended version conflicts with a number of state and federal laws and regulations and the Supreme Court's Olmstead ruling. Furthermore, forced discharges from training centers would also violate the state's settlement agreement with the DOJ, which is still in force. (From Judge Gibney's final ruling on the settlement: “no resident of a Training Center shall be discharged from a Training Center to a setting other than a Training Center if he or his Authorized Representative chooses to continue receiving services in a Training Center.”) Furthermore, the Virginia Code definition of "guardian" states that guardians are responsible for making residential decisions. A number of individuals were forcibly removed from CVTC's nursing facility to Hiram Davis Medical Center, and they may also be at risk, absent a language amendment, as Hiram Davis is associated with, and is on the grounds of, Central State Hospital. Please amend the bill's language to specifically exclude training centers and Hiram Davis Medical center, or oppose the bill.
HB 50 support. Currently Hiram Davis medical center Petersburg serves psychiatric and violent individuals in the same building as intellectual disabilities. Please prevent harm to defenseless Cognitive impaired. I have witnessed armed guards and sharing same hallways as intellectual disabilities populations. HB313, request amend to include Hiram Davis medical center and Sevtc Chesapeake Training Center. Equal protection and investigations for individuals with intellectual disabilities. HB 515 Oppose. Violates Olmsted Supreme Court case federal law protects choice by guardian. Lack of due process timeframe for Medicaid and Medicare recipientsm Individuals with profound intellectual disabilities cannot make their own decisions. Mental health discharges intended but remains Linked in the code section. See Olmsted and ADA federal laws. I'm a legal guardian for son Taylor Bryant at Hiram Davis medical center after displaced from CVTC. Vote No.
HB 515 This proposed change is apparently intended to permit DBHD bureaucrats to discharge patients with 15 days’ notice and without parental consent. Parental consent for Medicaid patients is required in the earlier language of section 3.C. This creates an ambiguity through which the Department can act until a court issues an injunction, which is not likely to happen in 15 days. There is no other reasonable explanation for this proposed change. It is my opinion that this is a sneaky bureaucrat-generated attempt to create a loophole to remove the powerful guardian consent limitation on their personal power. Most of the patients in State hospitals and training centers are of color (including my daughter). This amendment is clearly targeted at empowering the Department bureaucrats to discharge most of them on very short notice and over the objections of their families and guardians. The proposed change contradicts the long-existing language at lines 25-27. That right is protected by US Supreme Court case Olmstead v. L.C. (and settlement we had with Commonwealth in United States Court Western District of Virginia; attached.). This is bill is extreme and inhumane and negatively targets minority disabled population.
HB560 - Health insurance; coverage option for fertility services, essential health benefits benchmark plan.
I'm not sure which bill I'm commenting on entirely. All I know for sure is I'm a type 1 diabetic of 30 years. And our government seems to care very little about my health or the insane costs of the medication that I absolutely have to have to live. Or getting the care I need. Which has been expensive, and has kept me struggling to survive pay rent or see the many doctors I need to see. I am ready to share my story. About my lows where I wake up in the hospital then wind up with an $8000 hospital bill as well as a $4000 bill for a 10 minute ambulance ride. Or about my highs, or just about the struggle of being a Diabetic who was uninsured who struggles to survive in a government that seems to care more about pharmaceutical companies profits than it's citizens health. I have quite a bit to say on the subject and my struggles as a diabetic.
IVF should be covered by insurance in VA. One of my closest friends is dealing with this currently and it’s absolutely horrific and a terrible experience that nobody wants/chooses to go through. On top of that they shouldn’t need to deal with the financial stress of it all. Not being able to have a family shouldn’t depend on insurance and accessibility of care due to finances.
I have a close friend who is currently going through this. It has been heartbreaking watching this situation unfold in her life. I believe IVF should be covered by insurance in VA.
I support this bill.
I support this bill. As mothers who desires a pregnancy often need assistant to pro create and it is expensive to have a bundle a joy. What parent wouldn't desire a child to leave a legacy.
On behalf of the Alliance for Fertility Preservation (AFP) and the cancer patients we serve, I am writing to express our strong support for HB 560 and to urge the Labor and Commerce Committee to advance this bill out of Committee. Our full comments are attached.
To whom it may concern, I am advocating for this bill to pass and for Virginia to require employers to offer coverage for IVF without the diagnosis of unexplained infertility. My roommate from college and best friend went though a devastating situation where they lost their baby at 22 weeks due to a genetic abnormality that was found at their 20 week scan. Unfortunately, to alleviate this from happening again and avoid such heartbreak, they have to go through IVF in order to ensure their embryos are tested and the gene is absent so it is not passed on. They do not get IVF coverage and are therefore having to pay out of pocket just to avoid another traumatic experience and to be able to grow their family safely. IVF should be offered and covered for any family going through these awful experiences. Thank you for your time.
According to the National Infertility Association, RESOLVE, infertility affects 1 in 8 couples and 3 in 4 never obtain needed treatment, often because they cannot afford it. Everyone deserves the right to procreate and to try to build a family. Right now, many Virginia families diagnosed with infertility fall into a “coverage gap” and pay out-of-pocket for fertility care services. Only certain employers provide any fertility care coverage in Virginia and what they do provide is often very limited. Families generally must pay high co-pays or adhere to service restrictions and lifetime dollar caps that strictly limit their treatment options, and thus make it unaffordable for many of them to proceed without risking their financial security or without achieving a successful pregnancy. For example, 1 IVF cycle can cost between $12,000 and $25,000 and, on average, it takes 2 to 3 cycles to achieve pregnancy. Additionally, highly inflated managed care pharmacy prices for IVF medications, where families with coverage can pay as much as 100% more for medications compared to prices charged to self-pay families, often contribute to 25-50% or more of total IVF costs, which can quickly drain lifetime caps and severely limit overall IVF care options. According to the National Conference of State Legislatures, 15 states currently have laws regarding insurance coverage for infertility diagnosis or treatment, including Maryland which borders Virginia. This puts the State at a significant competitive disadvantage, as many reproductive age residents intentionally change employers and leave Virginia to gain more attractive fertility care benefits. It is also well-documented that individuals who self-pay for an IVF procedure, or have limited benefits, often demand that 2 or more embryos be transferred to their uterus. This greatly increases the risk of multiple births and is a dangerous and costly approach for heavily burdened health care resources and can be completely avoided with greater access to covered fertility care services. Studies show that states with insurance coverage have a lower rate of multiple births because fewer embryos are transferred. This bill requires insurers to cover fertility care services based on the current standard of care for IVF treatments to achieve pregnancy success rates for singleton births at the lowest possible costs. This will greatly reduce the risk of multiple births and greatly reduce hospital and health care costs, thus saving employers money. Several recent studies have found that the cost of perinatal and neonatal care for twins is about $100,000, whereas singleton pregnancies cost about $13,000. Triplet pregnancies can cost $400,000 or more. For every 100 pregnancies from IVF that are singletons but could have been twins, about $8.7 million dollars is saved on top of reduced pain and suffering for parents and premature babies. This bill would significantly reduce this high financial and societal burden by promoting IVF technologies that use single-embryo transfers. This bill could increase the number of persons treated for infertility while also decreasing health care costs.
Bringing an insurance mandate to VA to help cover IVF and fertility preservation would help so many people. When my husband and I faced our struggles in 2005, we have no coverage and spent more than $20,000 out of pocket for one IVF cycle. This put us in debt, held us back financially early in our marriage. It added extra stress to our infertility journey. A change in state law would help so many people access the medical care they need to start a family. Thank you Rebecca Flick Leesburg, VA
Hi, I have a close friend who has struggled with infertility coverage. She lost her baby at 23 weeks and has been denied IVF coverage because of Virginia’s current laws that deny coverage to someone who conceived naturally, despite having lost the baby due to genetics malformations that would likely happen again if she did get pregnant again naturally - leaving IVF as her best option. She and countless other women in VA should be able to receive coverage no matter what their fertility circumstances are.
Hello, I am Dr. Nancy Durso. I have been providing fertility services in the Northern Virginia area for over 30 years. I have seen fertility technology improve over this time, but I have not seen change in Virginia coverage. Most couples in their 20's and 30's are just starting out and don't have the resources for fertility treatment. Maryland and now the Federal Government have included options for fertility treatment. I have had patients who moved to other states or changed jobs to have coverage. The longer couples have to wait for treatment the less likely their chance of success. Not being able to have a family creates depression, family discord, low self-esteem and social imbalance. I have personally experienced infertility as well. Even though it has been many years the internal scars are still present. Having a baby moves couples past this roadblock and allows them to get on with their lives. The technology is available to help so many. Now is the time to move forward with this legislation. We can no longer say that these treatments are experimental since they have been performed for over 45 years! Help young Virginians improve their lives by financially supporting their dreams of having a child. Thank you.
My wife and I experienced a devastating pregnancy loss at 20 weeks this June. From there, it was determined that we would need to use IVF to prevent the same outcome in future pregnancies. You would think losing our daughter would be the most devastating experience we had all year, but what happened after with our insurance pushed us further and further into the depths. We were denied IVF coverage because it was not included in our insurance plan. We spent the next few months trying to determine how to navigate getting new insurance, while continuing to work with the team of doctors who supported us through our previous pregnancy. It was hell. We were suffer, grieving our loss, and dealing with help lines and 1-800 numbers having to share our trauma just to get someone on the phone to figure out how we could get the coverage we so desperately need. Couples that are experiencing infertility are already in hell. Having extra layers of complexity to navigate made the worst experience of my life even more unbearable. To be told that a team of doctors that was intimately involved in our situation all agreed that IVF with PGT was the correct course of treatment for us to build our family, BUT that coverage was not required in the state of VA and our employers didn’t include it in our plan was humiliating. It made grieving and recovery for me and my wife horrible and near impossible, knowing that we had almost no hope at the time of getting the coverage we so desperately needed to build our family. It is unfathomable that access to IVF is limited in the state of VA the way that it is. Men and women deserve access to the medical care that they need when they need it. Aside from being the right thing to do, it is also good for Virginia as a whole. Having accessibility will mean more jobs in VA, and more funding and research for infertility as a whole. Virginia has the benefit of being home to plenty of Fortune 500 HQs. This will also make those companies more attractive to talented employees, and equitable as a whole. Expanding access in VA for IVF is good for VA and so important for men and women who want to expand their families.
I am writing in support of HB 560. I was diagnosed with premature ovarian failure at 32, and after multiple rounds of IVF and other fertility treatments, I was able to have three beautiful children. It is without question that I would not have been able to build my family were it not for the incredible health insurance my employer provided at the time. But having insurance coverage for something as basic and essential as my ability to have children should not be something left to chance or good fortune. Indeed, it was my desire to have more children that kept me at this job in order to keep that incredible health insurance coverage, even when doing so impacted my career growth. Women should not have their ability to have children depend on the charity of their employers, and infertility should be treated the way that any other medical condition would be, especially given how core it is to one's humanity. Finally, this bill should be amended to include coverage for LGBTQIA individuals who should be equally protected in their journeys to parenthood.
Thank you for taking the time to discuss such an important issue. My husband and I are a member of the "one in twenty" club, and our two children (2.5 and 4 months) are among the small but growing percentage of children who were born using invitro fertilization. We were privileged enough to be able to "afford" IVF. I put "afford" in quotations, because we spent more than a year's salary to make our babies and ensure we could grow our family without a guarantee that it would work. We would do it again, including the emotional and financial heartbreak that occurred with the failures along the way. However, not everyone has the same outcome or the same resources. We strongly encourage you to consider supporting a bill that would make IVF accessible to all individuals who need it to grow their families, specifically a bill that would have it covered by insurance. As a state university employee, I found it frustrating that some state universities covered fertility benefits, but ours did not. Taking the financial strain out of the process will not take the pain and frustration away but it will lighten the load substantially and provide more equity across the board. Thank you for considering this bill!
As a Virginia resident and former infertility patient who underwent multiple rounds of fertility treatments, I speak for all families when I ask the committee to please pass HB560-Helmer. I was fortunate that my insurance covered some family building treatments, enabling my husband and I to undergo several courses of treatment. Even with some insurance coverage, we spent over $40,000 out of pocket. We were extremely fortunate to be able to afford this amount. It is not fair that so many want to build families but cannot afford to resolve MEDICAL issues because they are not covered by insurance. Please support Virginia families by requiring insurance companies to cover fertility treatments. Thank you.
At their 20-week ultrasound, my daughter and son-in-law first discovered that their unborn baby girl was severely compromised, with no expectation of life outside the womb. This heartbreak was followed by the discovery that one of them carries a genetic anomaly that will result in a 50-50 chance going forward that the same genetic defect will be present. The loss of their baby was traumatic; IVF will allow them to avoid repeating this scenario, as their fertilized embryos can be examined for this anomaly prior to implantation. An additional benefit is that the screening process means that this genetic defect will not be passed on to their future offspring, thus eliminating the possibility of the trauma their parents experienced with their first pregnancy. Our daughter and son-in-law's health plan does not cover IVF. They had to wait six months after the loss their baby for "open season", in order to switch health plans, which they have done. Waiting for open season was an additional burden to people who were struggling with the aftermath of their loss. In this instance it's so obvious to me that the small numbers of people who find themselves in this type of situation are deserving of assistance, and a solution that cost them burdensome waiting periods and astronomical costs. My daughter has a new health plan, and she's so fortunate they had this option, but they were extremely close to having to go it on their own, as many people undoubtedly must do. Making IVF available in all health plans would go a long way in saving the physical and mental health of expectant parents.
I am writing to express my support for H560-Helmer, to mandate IVF as covered healthcare policy for all Virginians. This is coverage Virginians are behind regardless of their individual positions on broader family planning, pregnancy, and child care issues. Please insure that this bill is included in legislation that makes it to Governor Youngkin for his signature this session. Thank you, Richard Moore Reston, Va.
If I didn't have insurance that covered fertility treatment, I couldn't have a family. If I couldn't have a family, I'd leave Virginia. Support families; mandate fertility insurance coverage.
After an emergency surgery robbed my husband and I the ability to conceive naturally, our arduous journey of IVF began. IVF is extremely expensive and there are no guarantees of a happy ending. One round of IVF can cost upwards of $10,000, multi cycle packages can run $25,000 or more, plus the cost of necessary, supportive medication that can run between $3,000-$10,000 a cycle. That doesn’t include all of the pre-testing typically needed in addition to several tests administered throughout the process. Our medical insurance did not cover any of the IVF costs, medications or testing. My husband and I went through three rounds of IVF and spent close to $100,000 out of pocket. Let me repeat that. We spent close to $100,000 on IVF and went broke doing so. We spent our savings, maxed out our credit cards and borrowed money from family. At one point we considered going overseas, as the cost of IVF is a fraction in comparison to here in the United States. Hindsight, would we do it again? Absolutely! Is it fair we had to endure immense stress due to the financial burden? …absolutely not. We are some of the fortunate ones that have a happy ending to our IVF story. We are truly blessed and realize how fortunate we are knowing others cannot even start the process because they simply cannot afford it. No one should EVER have to go in debt or be robbed of the opportunity to start a family. There is still a stigma that IVF is a “women’s issue”, when in fact only 1/3 of IVF cases are due to female factor. Insurance companies use this false premise to classify IVF as a niche issue and deny coverage. Let Virginia be among the progressive states that supports women’s reproductive rights! Make ART (Assisted Reproductive Technology) affordable and covered by insurance!
Esteemed representatives, It is my honor to let you know that my husband and I were privileged enough to have a daughter two years ago via fertility treatments. After three unexplained losses, it was a dream come true. My daughter is smart, adventurous, and I’ve never seen her fearful of anything. I would pay my life savings a million times over to hear her laugh just once. But the fact is - I shouldn’t have to. Around the time my daughter was born, my sister in law had a son via IVF in Maryland. Her out of pocket medical bills, while her treatment was significant more expensive than mine, were miniscule in comparison because of her insurance coverage. While my insurance did cover a small portion, we paid thousands of dollars for the opportunity to meet our daughter. This is not even a possibility for many because of the cost. The dream of a family should not come saddled with medical debt, loans, and even more hopelessness. I am sincerely and courageously hoping that you will expand the coverage required in Virginia to allow other families to hear their baby’s laugh for the first time. Please consider lessening the load and removing even a single obstacle for families with dreams like mine - to hear their baby laugh and see them smile. I appreciate your time and attention.
Dear Representative and House Committee, IVF insurance coverage is important to thousands of families in Virginia who build their families via IVF. Virginia needs to keep up with Maryland and Washington, DC when it comes to helping people build their families. Maryland was the first state to pass an infertility insurance mandate in 1985 and the District of Columbia passed the newest mandate in 2023. As a neighboring state, due to the emotional and financial costs of IVF, lack of resources draw families to leave the state or seek employment elsewhere. Passing this bill will not only support families but ensure financial stability in doing so. Thank you, Sarah
Virginians with healthcare are able to receive specialty care for almost any disease or ailment, so why not infertility? Please consider the diagnosis of infertility as serious as any other health problem and help expand benefits to include fertility treatments.
Dear representative and House committee. iVF insurance coverage is important to thousands of families in Virginia who build their families via IVF. Virginia needs to keep up with Maryland and Washington, DC, when it comes to helping people build their families. Maryland was the first state to pass an infertility insurance mandate in 1985, and the District of Columbia passed the newest mandate in 2023. As a neighboring state, due to the emotional and financial costs of IVF, lack of resources draw families to leave the state or seek employment elsewhere. Passing this bill will not only support families but ensure financial stability in doing so.
The Leukemia and Lymphoma Society strongly supports HB560 to provide for fertility preservation services for individuals facing iatrogenic infertility as a result of treatment for cancer.
My Name is Sarah Mong. I am 32 years old, and a 30 year resident of Virginia. Thank you for taking the time to review my written support for the passing of HB560- Helmer, which will expand IVF services to the residents of Virginia. My husband, Stephen, and I have an extremely complicated and heartbreaking circumstance surrounding our journey to IVF. We fell pregnant in January of 2023. Getting the positive pregnancy test with our daughter, Andie Isabel Mong, was the happiest day of my life. However, we suffered an immeasurable loss on June 2, 2023, when we lost our daughter in my second trimester. It’s difficult for me to put into words the impact of our loss, and the horror at learning 20 weeks into what we were told was a “low risk pregnancy” that our daughter had inherited a sever genetic condition that impacted nearly every single internal organ system, and wouldn’t survive. I can’t even describe the heartbreak Stephen and I feel that we do not get to love and raise our Andie the way we had hoped to. It feels like a failure of nature and of science that this could happen to us. Following the loss of Andie, genetic testing was conducted, and it was determined that Stephen and I, two healthy adults in our 30’s, who had conceived naturally, have a 50% chance of recurrence in future pregnancies. The only way to prevent a pregnancy like Andie’s, and to safely build our family, is through IVF with PGT testing. Every single medical professional we have consulted with has shared with us their recommendation that we pursue IVF with PGT testing. Given what we have suffered through, it feels like a miracle that the science exists to prevent further loss and suffering though IVF with PGT. However, my heart was broken again when our insurance approved our referral for PGT, due to our genetic diagnosis, but denied our referral for IVF because my employer had not included it in the health insurance plan I was on. PGT testing on embryos could not be conducted without pursuing IVF, and we cannot safely conceive children without IVF. While grieving the loss of Andie, an impossible journey in and of its self, Stephen and I tried to navigate the very complicated world of obtaining insurance coverage for IVF. As you can imagine, it was very important to me to stay with my OB and MFM from my pregnancy with Andie. It felt impossible to do my story justice to a new OB and MFM who were not there with us through all of it; the happiness, the joy, the shock, devastation and heartbreak. I physically and mentally couldn’t stomach the thought of brining a new provider up to speed, while dealing with the physical and emotional trauma of a second term pregnancy loss. Obtaining IVF coverage by switching plans would have required us to leave both our providers behind, as well as wait until a new year, when I was one year older and my eggs were of lesser quality, to pursue IVF. That weight felt like an impossible choice added to an already impossible situation. On behalf of myself, Stephen, and Andie, I hope that you will understand the necessity of opening up access to IVF. Women who are struggling to become mothers do not need any added stress or weight to what is already a soul-crushing experience. OB’s, MFM’s and Genetic Counselors are very well trained in making the determination of what necessitates IVF and it should be left up to them to make that call.
I am an infertile resident of Virginia who utilized IVF to start my family. I considered moving to Maryland and getting a job there to secure IVF coverage. Please do right by Virginians and offer us the coverage that's available in Maryland.
This law is needed to keep up with the health insurance trends of Washington DC and the State of Maryland. Many people around the nation postpone family building due to health insurance non-coverage/limited coverage of IVF, etc. In 2010, I borrowed 20,000 to build my family. Although this was a successful family building investment, the financial burden caused much stress.
I am speaking to my support of HB560. My family experienced infertility for over seven years. The diagnosis and subsequent treatments were difficult enough without the significant stress caused the financial impact . And that is for those fortunate enough to strive for IVF, which is completely cost-prohibitive for so many people. Infertility is not a lifestyle decision. I implore you to do what can to resolve the suffering it can cause.
As a Virginia resident since 1993, I urge the Subcommittee to support HB460-Helmer, because this bill is about building families. This bill would require certain employers in the Commonwealth to provide insurance coverage for medical treatments such as IVF and fertility preservation for cancer patients. This is standard healthcare, insurance that most self-insured employers are adding because they know the positive value of this benefit. It's a benefit that helps build families, retains workers, recruits talent, and ensures that employees don't suffer financially due to paying out of pocket for care. Did you know Maryland has had this kind of coverage since 1985, and the District of Columbia passed a similar law in 2023. As someone who went through IVF and had health insurance because my husband's company was based in Massachusetts with a strong mandate, having that healthcare covered by insurance allowed us to focus on our treatment, not stress about the finances. Thank you for considering this bill.
Please note my strong support for the IVF and fertility preservation bill. I have a 3 year old born from IVF, with my husband and I not being able to expand our family without help from IVF and science. I am one of the very few people to have insurance that covered most of my treatments ($50K+), but just because I am one of the lucky ones doesn't mean I don't fully support every American having the chance to start a family. Passing this bill will change so many lives, not only to expand families but to continue to grow and develop the youth of our country.
I was diagnosed with "unexplained infertility" last year. My insurance had no coverage whatsoever for infertility unless I had a medical diagnosis of infertility. With that being said, majority of my doctor's visits were paid out of pocket and we spend over $12,000 in medical bills just last year for testing, surgeries, and 3 rounds of IUI (which were all unsuccessful). We continue with our doctor's visits this year and plan on doing IVF which will probably be another $15,000 ($5,000 of that alone for medications ONLY) out of pocket depending on deductibles and co-insurance. That itself is nearly $30,000 spent just to start of family, when there are people who have no issues getting pregnant and do not need to spend a dime. There are so many people who do not even have the option to seek help with infertility because of the financial costs. Virginia MUST make changes to allow EVERYONE to have infertility insurance coverage.
Sometimes people need a little help when it comes to building their family. Unfortunately the out of pocket cost associated with fertility treatments is unreachable for many families, costing $20k+ for a single treatment, the the expense (and stress) is compounded if a family needs multiple rounds of treatment. Insurance coverage will bring down the costs, and allow Virginians to build the family of their dreams. I am getting ready for my fourth total round of fertility treatment, and the expense is devastating, but I want a second child so so much to complete my family—I want my son to have a sibling, and my husband and I love being parents so much. Please support HB560 to build Virginia families like mine.
IVF costs are beyond what normal Americans can afford, without going into crippling debt. The only reason my husband and I have been able to afford IVF to try and build our family is because he has partial coverage through his job. We've been spent $5,000 out of pocket and that number is growing. Fertility is healthcare, and all Virginians deserve access to it, regardless of income.
I am writing to express my support for the fertility insurance coverage bill. Access to comprehensive fertility treatments is an essential component of reproductive health care, and ensuring that individuals and families have the necessary. Support is a matter of both equity and compassion.. Fertility challenges can be emotionally and financially taxing and providing inclusive insurance. Coverage is a crucial step towards alleviating the burdens associated with ART. By extending coverage to include fertility treatments, the state can make significant strides in supporting individuals and couples on their journey to parenthood. This initiative aligns with the evolving, understanding of healthcare, recognizing fertility as an integral aspect of overall well-being. It reflects a commitment to the diverse needs of Virginians, fostering a community where everyone has the opportunity to build the families they desire. I urge you to champion this cause common, ensuring that fertility insurance coverage becomes a reality for all residents of Virginia. By doing so, you will be contributing to the establishment of a more compassionate and inclusive healthcare system that meets the diverse needs of our community.
On behalf of the Virginia Association of Hematology and Oncology (VAHO) and the Association of Clinical Oncology (ASCO), I have attached a letter in support of HB 560.
HB570 - Prescription Drug Affordability Board; established, drug cost affordability review, report.
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The International Foundation for Autoimmune & Autoinflammatory Arthritis (AiArthritis), a patient organization led by people affected by AiArthritis diseases, shares the committee’s goal of lowering patient out-of-pocket costs so that they can more easily maintain their health. However, we urge the committee to reject empowering a prescription drug affordability board (PDAB) to lead these efforts, which could ultimately cause more harm by creating more barriers between patients and their needed medications. AiArthritis has been actively involved in other states that have recently implemented local PDABs, including Colorado and Oregon, and have seen firsthand the limitations of the PDAB model in those states. Based on what we have seen, we believe that PDABs are ineffective in identifying and solving the actual problems patients with chronic conditions are facing when attempting to access their medications. Focusing solely on the price of drugs ignores the many complicated factors that ultimately drive costs up for patients and oversimplifies a very complex process. To employ a healthcare analogy, with PDABs policymakers are seeking to address a symptom rather than the underlying condition. We encourage policymakers to focus on these existing and pressing affordability and access issues, which originate from payers (insurance companies and pharmacy benefit managers (PBMs)). Additionally, reviewing only a handful of medications positions PDABs to create further inequities, picking winners and losers among patients and patient populations. We urge your committee to focus instead on the broader healthcare industry when considering reforms and identify long-term solutions rather than short-term relief for a limited few. Some PDABs have been given the authority to review prescription drug costs and set upper payment limits for them. Setting upper payment limits (UPLs) for drugs might endanger their accessibility in the state or limit appropriate reimbursement for the physicians that administer them. Patients with complex and chronic conditions often spend years identifying treatments that work for them. UPLs will not lower prescription drug costs for patients because they do not lower out of pocket costs. Additionally, treatments can also work for years but then become less effective, forcing patients to change therapies. There is no “one size fits all” health solution; therefore, it is critical that health policies do not impede access to treatments or lead to fewer options for patients. Proposals such as these target the most innovative medicines, disproportionately impacting patients with diseases where there is high unmet need and where low-cost treatment options are not available (e.g. rare diseases), running counter to the aims of personalized medicine and availability of new treatments.
Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
I am here to speak and endorse Del. Delaney's Prescription Drug Affordability Board bill.
My dad is battling stage 4 prostate cancer. He was diagnosed on 4/27/2023 and on 6/15/2023 we learned it was all over. Things looked scary yet we learned about a drug called Xtandi that could keep him with us longer. It is $8800 a month and we started going through the process of getting insurance to approve it. If they did approve it the cost would be $1905 a month. My parents are retired teachers and my dad gave 36 years to the students in Welding and Ag classes. My brother and I vowed they would get whatever they needed to fight this monster. I learned $8800 is pretty cheap for a life sustaining drug. $25,000 up to $90,000 is what some are charged. 1 in 4 Virginians don't take the right amount of prescriptions because of cost. My dad is lucky that we've made it work yet he taught me to look out for others. When you're fighting for your life you don't have the time to fight for drugs that will save you. Please support this bill and make it easier for others to get their prescription drugs. I'm currently on leave from my job to care for my dad and help my parents. If you need to ask any questions please feel free to email at robing98@gmail.com. Please vote the right way!
I'm not sure which bill I'm commenting on entirely. All I know for sure is I'm a type 1 diabetic of 30 years. And our government seems to care very little about my health or the insane costs of the medication that I absolutely have to have to live. Or getting the care I need. Which has been expensive, and has kept me struggling to survive pay rent or see the many doctors I need to see. I am ready to share my story. About my lows where I wake up in the hospital then wind up with an $8000 hospital bill as well as a $4000 bill for a 10 minute ambulance ride. Or about my highs, or just about the struggle of being a Diabetic who was uninsured who struggles to survive in a government that seems to care more about pharmaceutical companies profits than it's citizens health. I have quite a bit to say on the subject and my struggles as a diabetic.
discussing impact of changes to payment structure for independent infusion centers.
I am the Executive Director of the Rare Access Action Project. My family has been affected by rare diseases. Because of that I have spent much of my career in the life sciences advocating for access to rare disease therapies and supporting rare families. Only 5% of rare diseases have an FDA approved treatment. For one-third of individuals with a rare disease, it can take between one and five years to receive a proper diagnosis. Half of all patients diagnosed with a rare disease are children, and as many as 3 in 10 children with a rare disease will not live to see their 5th birthday. For the few fortunate to have a treatment, patients face barriers to these therapies across our health care system in addition to facing a patient journey filled with misdiagnosis and lack of treatment options. Having seen PDABs in other states, we are very concerned. Since the first PDAB was created in 2019 by the Maryland legislature, PDAB legislation has been passed in 8 states (Colorado, Maine, Michigan, Minnesota, New Hampshire, Ohio, Oregon, and Washington). Since 2019, the experiment in government drug price controls has amassed a dubious record of success. Maryland, the oldest of the PDABs, has yet to become operational, and others have struggled to fulfill their mission. The pharmaceutical ecosystem is more complex than proponents portray it, and PDAB legislation patches on a state bureaucracy with little understanding of pharmaceutical pricing policies and the implications of their decisions. Pharmaceutical products are purchased across the United States with Virginia involved in an interstate marketplace that includes a network of federal and state discount and rebate programs (Medicaid best price, 340b pricing, VA, FFS as well as the calculations and penalties that are attached to them). Further, many commercial plans and PBMs negotiate substantial discounts, and some payers have already begun to implement value-based pricing. States such as Arizona are exploring risk pooling for therapies and the uninsured, as well as reinsurance. Price controls from PDABs could jeopardize efforts to innovate value and payment in the pharmaceutical ecosystem. Also consider, rare disease patients increasingly participate in Center of Excellence care. Universities and larger hospital systems have become hubs for both care and treatment. Drugs are purchased and administered for some rare patients outside of Virginia. Challenges will face Virginian rare patients who are on a therapy purchased outside the state beyond the purview of the Virginia PDAB. And payment for those medicines will create risk for those providers, potentially choking off access to that necessary treatment. We urge you to ensure that no patient is left fearful of losing access to treatments that offer them a chance at a better tomorrow. We believe there are solutions that can enhance affordability across healthcare. But proponents of PDAB are focused on an experimental program that has generated zero savings for patients since the first PDAB was created in 2019. We urge you to vote no on HB570. We look forward to working with you on meaningful solutions to healthcare affordability.
The Biotechnology Innovation Organization (BIO) respectfully opposes HB 570, which would create a Prescription Drug Affordability Board tasked with reviewing prescription drug costs and setting upper payment limits for specified prescription drugs. Government price controls like those proposed by this bill are an especially drastic action with unpredictable consequences. While the intent of this bill is to lower drug prices, we fear HB 570 will fail to bring down costs for consumers or institutions and instead disincentivize development of new therapeutic breakthroughs. This bill will not lower prescription drug costs for patients because it does not address out-of-pocket costs. Patients pay a given price when they visit a pharmacy based on what their health insurer determines—it is for this reason why two patients will pay a different price for the same drug. Out-of-pocket costs have been rising for patients as a result of decisions made by health insurers. HB 570 does not address the price patients pay out-of-pocket and will therefore not directly impact patient affordability for prescription medications.
Please see the attached letter from The Biotechnology Innovation Organization (BIO) in opposition to HB 570.
Small business support for PDAB and why it's critical to my workforce.
HDA respectfully opposes HB 570, Establishing a PDAB. HDA is the national trade association representing healthcare wholesale distributors — the vital link between the nation’s pharmaceutical and healthcare manufacturers and more than 330,000 pharmacies, hospitals, and other healthcare settings nationwide. Wholesale distributors are unlike any other supply chain participants. Distributors are primarily responsible for the physical handling and logistics of medicines and healthcare products, and have no role in determining the list prices for drugs or the amount patients pay at the counter. Rather, HDA members ensure that over 95% of all pharmaceutical products arrive to over 5,800 sites of care in Virginia. While HDA supports the state’s efforts in seeking a better understanding of the prices that consumers see at the pharmacy counter, based on our members' supply chain expertise, we have strong concerns regarding the upper payment limit (UPL) established in the legislation, the use of maximum fair price (MFP), and the impact of these policies on the physical supply chain. State-level UPLs do not adequately reflect how prescription drugs are bought and paid for in the U.S. A state-level UPL, especially a UPL following federal MFP limits, would place caps on in-state purchases but not out-of-state purchases, ultimately limiting the ability of pharmacies, clinics or other points of care to recoup costs for administering or dispensing these products, which could result in sites of care being unable to stock these medications. In short, a UPL puts patient access to timely medications at risk. While HDA is concerned over the impact of this type of proposal, we would like to express our appreciation for the inclusion of “a representative with knowledge in…supply chain business models” on the Stakeholder Council. As noted, wholesale distributors do not set list prices or play any role in determining the amount patients pay for medicines at the counter, our members are the logistical experts of the supply chain, and HDA believes it is important that the stakeholder council is representative of the full supply chain. We invite the Committee to review our full letter, and to contact HDA at any time to discuss why we oppose HB 570. Thank you for your consideration of our concern.
Tigerlily Foundation is a national women's oncology organization providing education, advocacy, & hands-on support for young women before, during, & after cancer. I write to you today to express our organization’s concerns over HB 570, legislation that would establish a prescription drug affordability board (PDAB) in Virginia. Establishing a PDAB in Virginia will block access to essential medicines that Virginians rely on to manage symptoms & lead healthier lives, particularly for patients living with cancer & other chronic conditions & could further exasperate already existing health inequities. Prescription drug price setting policies that often accompany PDABs, such as upper payment limits (UPLs), fail to protect access to timely & effective care & can actually increase risks for patients who need consistent access to medications to manage their health. UPLs limit reimbursement for hospitals, doctors, & pharmacists who dispense effective treatments that help patients manage disease. As a result of the proposed PDAB, Virginia patients could be forced to search elsewhere to access medications they need & could end up forgoing critical treatments altogether, which can lead to adverse health consequences including death & higher medical costs in the future. In addition, establishing a PDAB in Virginia could divert critical research resources elsewhere & have a chilling effect on the development of new medicines for patients who have limited or no treatment options today for their condition. Furthermore, any proposed PDAB should be designed to include patients & be representative of those populations. This would also include patient advocacy organizations as community advisory representatives of the Virginia House to ensure that these & future recommendations include all stakeholders. For patients who are diagnosed with complex cancers like triple negative breast cancer (TNBC), a hard-to-treat type of breast cancer that has limited treatment options & is diagnosed in Black & Hispanic women at younger ages & later stages, timely & equitable access to medical treatments prescribed by one’s physician is critical. However, drug price controls can unintentionally threaten vital pathways for patients to access cutting-edge medicines that can help them survive disease. While we commend the Virgina General Assembly & other elected leaders in Virginia for exploring solutions that alleviate health care access & affordability challenges & reduce health disparities, any policy solution must not come at the expense of vulnerable communities in Virginia, particularly Black & brown communities who already face disproportionate barriers. TNBC, among other cancers and diseases, disproportionately affects Black women, & establishing a PDAB in Virginia would have disastrous consequences on access to care, future innovative treatments, & efforts to achieve health equity. On behalf of the communities Tigerlily Foundation serves, we thank you for your leadership in seeking policy solutions to address barriers to care that Virginia patients face. However, HB 570 falls short of that goal. On behalf of our community & as an 18 year survivor of TNBC myself & a Virginia resident, I thank you for your consideration of our concerns. Please do not hesitate to contact me directly at maimah@tigerlilyfoundation.org if Tigerlily Foundation can be a resource to you and your staff. Sincerely, Maimah Karmo Founder & CEO , Tigerlily Foundation
Thank you for the opportunity to submit comments. Please see the attached letter.
The National Infusion Center Association (NICA) is a nonprofit organization formed to support non-hospital, community-based infusion centers caring for patients in need of infused and injectable medications. Our organization writes to express concerns with the Board’s ability to establish an upper payment limit for prescription drugs. We applaud Virginia lawmakers for attempting to address drug costs for patients, and we appreciate that the bill notes this will be done with consideration for administration costs. However, we are still concerned that an upper payment limit will not only fail to achieve the intended goal, but it will also harm vulnerable patients in the process. Establishing a ceiling for how much an infusion provider can be reimbursed for a drug will disrupt the delicate economics of medical benefit drug delivery and put smaller, community providers—that represent the lowest-cost care setting for these expensive medications—at risk. Infusion providers typically acquire, administer, and bill for drugs through a buy-and-bill model. Under this model, providers are reimbursed for drugs they previously purchased and stored along with a small payment for professional services that does not begin to cover the overhead of their business, known as the admin fee. To remain in business, infusion centers rely on their drug payments to offset the incredible cost-reimbursement disparity on the professional services side. Drug payments are the economic lynchpin to offset practice expenses, including inventory management, staff salaries, and office space. Lower drug payments to infusion providers will force most of the state’s community-based infusion centers to shutter their doors or discontinue administering certain drugs, forcing patients into more expensive hospital care settings or potentially ending their treatments. Upper pricing limits put a ceiling on the reimbursement for certain drugs, but they do not guarantee that the drug will actually be cheaper for patients. An upper payment limit will only establish how much insurers in the state pay for a drug. It will not change the actual cost of drug acquisition and administration for providers, and it will not change what insurers require from patients through copays and coinsurance (most infusion patients use copay assistance to cover the cost of their medications, which insurers are trying to prevent through copay accumulator programs). Though well-intended, we fear that upper payment limits will harm infusion providers and their patients, leading to access issues across the state. Taking time to better understand the buy-and-bill model that most, if not all, infusion providers rely on, will only benefit the welfare of providers and patients in the state. We hope that the Committee will be open to exploring other options, such as an amendment that would exempt infusion providers from the impact of this bill - a provider carve-out. This would avoid disruptions to community-based care delivery and keep Virginia infusion centers and patients safe.
January 31, 2024 RE: Written Testimony for House Committee on Health and Human Services February 1, 2024 hearing for HB 570 by Delegate Delaney. The National Minority Quality Forum (NMQF) is a 501(c)(3) not-for-profit research and advocacy organization based in Washington, DC. The mission of NMQF is to reduce patient risk by assuring optimal care for all. Our vision is an American health services research, delivery and financing system whose operating principle is to reduce patient risk for amenable morbidity and mortality while improving quality of life. NMQF is committed to reducing patient risk and ensuring equitable access to beneficial treatment and care for Virginians and communities nationwide. The National Minority Quality Forum is writing to you to share our concerns that a Virginia Prescription Drug Affordability Board (PDAB) may only serve to impede the progress toward achieving health care equity for all Virginians. Price setting policies that accompany the PDAB such as an upper payment limit (UPL) increase risks for amenable morbidity and mortality for patients who depend on Medicaid to assure effective and consistent access to prescription medications to manage their health. UPLs limit reimbursement to hospitals, doctors, and pharmacists who dispense drugs deemed the most effective to help patients manage a chronic condition. While healthcare systems that serve a patient mix with higher-income levels may be able to withstand the losses from the lack of reimbursements, hospitals that are responsible for disenfranchised communities may not. Ensuring the affordability of high quality, efficacious medications is essential to the elimination of inequities in health care and outcomes. This affordability must not be effectuated by promulgating public policy that increases the health and financial costs vulnerable populations and communities in Virginia, particularly rural, Black and brown communities who are reliant upon and equity-centric public policy construct. Price setting policies that confound access to care are a barrier to inclusion in data collection and investment in research efforts that improve the quality of care for historically excluded populations. In closing, the National Minority Quality Forum shares your concerns regarding the need to assure that Virginia’s health care safety net is financially viable; however, that financial viability must not service to compromise the health and financial security of Medicaid beneficiaries. We would welcome an opportunity to partner with the Commonwealth of Virginia to explore effective and sustainable policy avenues to improving the quality and outcomes of care for all Virginians. If you have any questions regarding this public comment, please direct them to Gretchen C. Wartman, NMQF Vice President for Policy and Program (gwartman@nmqf.org). Sincerely, Gary A. Puckrein, PhD President and Chief Executive Officer National Minority Quality Forum
I am submitting my statement in support of HB 570, PDAB, patroned by Del Delaney. I must take four injections per year of Skyrizi which has a co-pay of thousands of dollars per injection. Medicare pays the rest of the cost. For Virginians who are not on Medicare, they must pay as much if not more, subject to their private insurance. If on Medicaid., then the Commonwealth must pay the entire cost. HB 570 will limit Virginians copays by capping the upper limit that can be charged for these medications. Tens of thousands of Virginians, like me, must take expensive prescriptions or allow their health to suffer by not taking prescriptions. I will be protected by the Biden Adminisrtation's Inflation Reduction Act which this year and in 2025 will continue to limit my copays. But Virginians not on Medicare will not have this opportunity. This situation exists because Skyrizi remains on patent. I don't have a choice. As a taxpayer, I will also benefit because the Commonwealth will spend less on prescription drugs for those on Medicaid, those using state health plans and prison inmates. The savings of millions of dollars spent by the state will be greatly appreciated by the constituents of the General Assembly and the Governor when this bill is signed into law. Thank you.
Thank you for accepting my letter in regard to HB 570. I represent cystic fibrosis patients in VA who are rightly concerned about the prospect of a Prescription Drug Affordability Board. On their behalf we ask you to read the attached letter and stop moving this bill forward. At the very least seek advice from as many advocates like me as possible. The patient voice needs to be heard, they should have a voice on the board, an appeals process and more. Thank you. Laura Bonnell
Please allow us to share our written testimony for Thursday’s House Hearing on HB 570. We write to share our deep concerns of the potentially devastating impact of the newly proposed Prescription Drug Affordability Board (PDAB) on patients living in Virginia. The attached letter outlines these concerns in detail. We would be happy to discuss these concerns more or answer any questions you have. The Alliance for Health Innovation (Alliance) is a group of diverse cross-sector stakeholders that together represent patients, providers, caregivers, academia, biopharmaceutical innovators, and business communities. Led by the Global Coalition on Aging (GCOA), the Alliance is committed to establishing the importance of innovation in achieving healthy aging and advocates for state policy solutions that support a thriving innovation sector that enables Virginians and other communities to live longer – and healthier – lives.
Honorable Chairman Ward, Vice Chair Herring, Members of the House Labor and Commerce Committee, and respected staff, Community Access National Network is gravely concerned with the nature of HB 570 as a "quick fix" to complicated issues, posing serious threats to access of timely treatment for people living with HIV in the state of Virginia. Attached is a detailed letter of concern regarding the proposed prescription drug advisory board. As a patient group, our first and foremost concern is the bill's abject lack of focus on patient perspectives and failure to prioritize patient experience as an aimed outcome. In our experience in other states, namely Colorado, boards lacking specified patient voices are dismissive and otherwise unresponsive to patient concerns. This is especially troubling as PDABs are typically targeting medications used to treat rare diseases, cancer, and public health concerns, like HIV and Hepatitis C - threatening patient access to lifesaving care. Similarly, these boards tend to lack expertise across the drug channel and are exceptionally selective in pursuing information - often neglecting to consider conflicts of interest with contractors serving the board or failing to disclose these conflicts. Nothing in HB 570 requires assessment or monitoring of potential unintended consequences. Nothing HB 570 requires pass through of any "savings" to patients or plan sponsors. Rather HB 570 seeks to establish "winners" and "losers" among industry interests while leaving patients behind. Whether the "winners" are pharmacy benefit managers or particular manufacturers, patients are removed entirely from decision making of our own care but for the mere afterthought of public comments. CANN urges the committee to seek a different route, one focused on patients, evaluating barriers to care, like consolidation of the provider and pharmacy spaces, addressing payor originated administrative burdens, and tackling the self-dealing nature of "vertical integration" among these interests at the expense of patients, our employers, and the state. This is NOT that bill. We urge you to vote NO on HB 570. CANN is ever at your service and happy to discuss real solutions for patients, should the legislature find the pleasure to do so.
I am the Executive Director of the Rare Access Action Project. My family has been affected by rare diseases. Because of that I have spent much of my career in the life sciences advocating for access to rare disease therapies and supporting rare families. Only 5% of rare diseases have an FDA approved treatment. For one-third of individuals with a rare disease, it can take between one and five years to receive a proper diagnosis. Half of all patients diagnosed with a rare disease are children, and as many as 3 in 10 children with a rare disease will not live to see their 5th birthday. For the few fortunate to have a treatment, patients face barriers to these therapies across our health care system in addition to facing a patient journey filled with misdiagnosis and lack of treatment options. Having seen PDABs in other states, we are very concerned. Since the first PDAB was created in 2019 by the Maryland legislature, PDAB legislation has been passed in 8 states (Colorado, Maine, Michigan, Minnesota, New Hampshire, Ohio, Oregon, and Washington). Since 2019, the experiment in government drug price controls has amassed a dubious record of success. Maryland, the oldest of the PDABs, has yet to become operational, and others have struggled to fulfill their mission. The pharmaceutical ecosystem is more complex than proponents portray it, and PDAB legislation patches on a state bureaucracy with little understanding of pharmaceutical pricing policies and the implications of their decisions. Pharmaceutical products are purchased across the United States with Virginia involved in an interstate marketplace that includes a network of federal and state discount and rebate programs (Medicaid best price, 340b pricing, VA, FFS as well as the calculations and penalties that are attached to them). Further, many commercial plans and PBMs negotiate substantial discounts, and some payers have already begun to implement value-based pricing. States such as Arizona are exploring risk pooling for therapies and the uninsured, as well as reinsurance. Price controls from PDABs could jeopardize efforts to innovate value and payment in the pharmaceutical ecosystem. Also consider, rare disease patients increasingly participate in Center of Excellence care. Universities and larger hospital systems have become hubs for both care and treatment. Drugs are purchased and administered for some rare patients outside of Virginia. Challenges will face Virginian rare patients who are on a therapy purchased outside the state beyond the purview of the Virginia PDAB. And payment for those medicines will create risk for those providers, potentially choking off access to that necessary treatment. We urge you to ensure that no patient is left fearful of losing access to treatments that offer them a chance at a better tomorrow. We believe there are solutions that can enhance affordability across healthcare. But proponents of PDAB are focused on an experimental program that has generated zero savings for patients since the first PDAB was created in 2019. We urge you to vote no on HB570. Our written testimony is included in an additional document.
Letter attached
Thank you to Chair Ward and Members of the House Labor and Commerce Committee for the opportunity to weigh on an issue that directly affects the health and wellbeing of the patients I serve. I write to you to ask for your support for HB570 in establishing a Prescription Drug Affordability Board in Virginia. As a physician who has practiced in our Commonwealth for years, I see every day how patients struggle to pay for expensive medications that I prescribe. Because every individual is unique, with unique health needs, doctors prescribe the best medications that are tailored to best meet the special needs of our patients. Unfortunately, prescription drugs are becoming more expensive every year. And when prescription drugs become more expensive, my patients feel the pinch. For those who have to pay out-of-pocket, prescription drugs can be downright unaffordable. In some cases, my patients have told me that they pay thousands of dollars for medications they need to be healthy. Many Virginians are in the same boat. Too many of them are skipping their medications or splitting pills. A majority of Virginians are concerned they won’t be able to pay for their prescription drugs. Prescription drugs don’t work if people can’t take them. Medications don’t work if people split pills and skip them every other day. And in the case of certain medical conditions, not taking medications as prescribed can have harmful, even potentially deadly, consequences. No patient should have to ration their care. No patient should be denied their medications because cost is a barrier. By creating an independent panel of health care experts who will weigh data and involve all stakeholders, we can begin the work of bringing down high drug costs and finally bring some balance and fairness to a health care system that has long squeezed hardworking Virginia families. For these reasons, I strongly encourage you to support HB570.
Details in attached memo.
Thank you for the opportunity to submit testimony in support of House Bill 570 to create a Prescription Drug Affordability Board. As a physician, I know too well how critical access to prescription drugs is for my patients. Prescription drugs are a key tool in a doctor’s toolbox for helping patients manage health conditions, prevent complications from illness, and improve quality of life. But right now, too many of my patients simply cannot afford the drugs I prescribe them. They may be forced to take a less effective, more affordable alternative, split pills, or just forgo their medication altogether. These patients aren’t alone — 1 in 4 Virginians who depend on prescriptions chooses not to take those medications solely because of the cost. At the same time, large pharmaceutical companies are making record profits. The largest one nearly tripled its earnings over the past two years, making $100 billion in revenues. In 2023, pharmaceutical companies hiked the list prices for 112 drugs at a rate higher than the rate of inflation. No Virginian should be forced to split or skip pills while pharmaceutical corporations are making money hand over fist. It’s time for lawmakers to take action. Doctors like me support the creation of a Prescription Drug Affordability Board to lower the cost of medicine by setting cost limits on how much patients will pay for certain medications. We trust that the health and medical experts who comprise the Board will use a data-based approach to set reasonable rates for patients to pay. By creating a Prescription Drug Affordability Board, Virginia lawmakers can help hold greedy pharmaceutical corporations accountable and make the market more fair. But more importantly, you can help my patients and all Virginians who rely on prescription drugs better afford the medications they need to live and thrive. I urge you to pass HB 570 without delay.
Chair Sickles and Members of the Committee, On behalf of the Arthritis Foundation, representing the nearly 60 million Americans and 26% of Virginia residents living with doctor-diagnosed arthritis, we would like to provide comments on HB 570, a bill to create a Prescription Drug Affordability Board (PDAB). People with autoimmune forms of arthritis often rely on biologic medications to maintain their health, and as these are expensive medications, issues of high drug costs and access are always a top priority. Please find the attached comments for information only on this legislation and considerations for those living with arthritis in Virginia. Thank you for your consideration. Melissa Horn Director of State Legislative Affairs, Arthritis Foundation
HB594 - State plan for medical assistance services; payment for certified community health workers.
We are need in our communities
We Need Your Support! We were taught that doing small things in a great way is as important as doing great things. However, this isn't always true. Community Health Workers play an essential role in various communities across the state. They perform admirable work, whether it's addressing small, medium, or large tasks. Unfortunately, these positions are at risk of being defunded or disappearing in the next few months. This situation will impact vulnerable people in the communities that really need them (CHWs) the most. One potential solution to this problem is identifying sustainable reimbursement mechanisms that can support and expand the CHW workforce.
My name is Tameca Day and I am an active member of my city and state. It is apparent that our city needs more help in multiple areas and that these issues need immediate attention. As a member of the CHW community it is my understanding that we can greatly assist in small ways that make a huge impact. To continuosly push these efforts we will need to procure and maintain funding to protect our vision. This idea is not an individual security. This mission will continue to rest on the shoulders of those providing and those who seek assistance from trusted liasons where they reside. My hopes are that we can put aside differences and uplift RVA.
I support the organization that is doing all this so that our voice is heard since as health promoters we need a lot of support.
Health promoters need to be given greater support to take care of our community with more resources such as: medical insurance, more health supplies, support for the language barrier
I am the husband of CHW member who give their all to the community with action from going to Door to Door, having social gatherings to inform the community of change to come and how resident can improve and become more successful engaged with their own communities. I have witness with my own eyes the effort and success that CHW have provided for families in need as well as health awareness they provide for resident who may have never knew about so many resources that help in their personal lives. With being in house I am able to see the day to day action of a CHW who put there community first with early morning and late night commitment to helping individuals as well as their families during crisis times including the joyous times once a goal is completed through celebration of a job well done. Back during Covid outbreak it was very challenging time for CHW because they were the liaison between the hospital/ clinic to inform the community about vaccines and Information that was urgently needed on how to treat symptoms, as well how protect against different variants. So being just the husband of the CHW I feel happy for be part of a on growing team who love the their community and willing to go above and beyond to help the residents in it. I believe it in the blood sweat and tears of CHW who want to make there community a better place for all. Just like my great aunt Geraldine Evans in the 90s who took it apon her self to advocate to have a traffic light and crosswalk provided for children crossing the street to achieve their education in school safely. Her name is still labeled and posted on the corner of Muary st and 16th st in Blackwell community with her action she has been titled as The The Mother of Blackwell community. To me that’s the true definition of a CHW at their best . CHWs always be the one of the key pillars of a community. Thank You Dominique Jackson
Mi nombre es José Roberto Sosa soy del area de Williamsburg y soy Promotor de Salud, yo estoy a favor de esta ley, por que e notado los cambios y las diferencias cuando los promotores de salud ayudan a la comunidad.
Dear Delegate Sickles, My name is Jackie Green-August, and I am a certified community health worker in Southside, Virginia (Piedmont Region). I became a CHW because I live in a rural community of 15,535 individuals who rely on three physician practices, several dentists, no specialists, one supercenter, one grocery store, and 11 dollar stores to keep my community healthy. A few years ago, when I learned our county was at the top of the list for the prevalence of Diabetes, I decided I needed to educate people about how to maintain optimal health. Today, I provide a food distribution that feeds 400 people and teach Diabetes Lifestyle Change classes. In small rural communities like mine, the community health workers provide routine check-ins between doctor visits. As a CHW, I offer blood pressure and weight checks, health screenings, food, free fitness classes, SNAP and Medicaid application assistance, and doula services. I connect patients to telehealth, transportation, free clinic visits, and legal aid. I am also a CHW mentor, ambassador, and supervisor, teaching others how to improve their communities through outreach and education. You must hear my story to understand the importance of community health workers and our vital roles in the health and well-being of our families, friends, and neighbors. As CHWs, we request recognition for our work and value. Please amend the state plan for medical assistance services to include a provision for payment for services provided by certified community health workers. Thank you for this opportunity to comment on HB594 and explain its importance.
HB909 - 1915(c) Home and Community Based Services Medicaid Waivers; state plan amdmts., prog. modifications.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
My name is Donald Benson, and my wife and I recently adopted my almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of many disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. • ‘new guardrails’ that will compel many parents of minors to become employees of agencies and demonstrates a bias in favor of agencies and institutions. This makes a mockery of consumer directed service option. • Modify the 40-hour-per-week work limit to allow legally responsible individuals (LRI) with more than one waiver-receiving child to receive reimbursement for 40 hours of work per week per child receiving a waiver; Soft Cap of 56 and this still penalizes families with multiple waiver children • Eliminate the requirement that, in order for a legally responsible individual to receive reimbursement for personal care services, no one else be available to provide services to the member; No other state agency makes the Parent the last option and to be honest if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. Even though the system does not function correctly without these parents, these guardrails seem to assume the worst of intentions on the part of these same parents. • Allow a legally responsible individual or stepparent to be the employer of record when a member under the age of 18 receives personal care through consumer direction. EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents and forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. • DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. o In recent public communications as well as Emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion” • the guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families and in the eyes of many treat these families as guilty until proven innocent.
My name is Donald Benson, and my wife and I recently adopted our almost 4 year old daughter that was severely abused and traumatized by her bio-father and left with injuries that will affect her for the rest of her life. She is a bright, loving, and amazing miracle and I would not trade her for anything, but due to the trauma she has had it is very hard for her to trust others and especially with her personal care. My daughter is one of over 1700 disabled children and families that are being affected by the proposed changes which are scheduled to go into effect on March 1, 2024. Unfortunately, DMAS is making it much more difficult for parents (of minors) to be reimbursed for providing personal care for their child. DMAS is enacting ‘new guardrails’ that will compel parents to become employees of agencies. This makes a mockery of consumer directed service option and demonstrates a bias in favor of agencies and institutions. DMAS has failed to address significant problems with these guardrails such as the finding and enrolling of new consumer directed providers due to shortages and delays in the processing of forms needed to hire attendants. To be honest, if it wasn’t for the fact that many parents step up to provide care for their family member- the system would collapse. It seems strange to me that even though the system does not function correctly without these parents, DMAS would rather assume the worst of intentions on the part of these same parents. I understand that there may be bad actors but to implement a system where parents are treated as guilty of this until proven innocent is absurd. This is not the assumption with the any other state agency. Honestly no parent is making a living off of the under $13.50/hr. that most of the state is reimbursed for this care. Teenagers working in fast food make more than that. DMAS is also making it impossible for parents to be the EOR (Employer of Record). The EOR is an unpaid position that also has significant access to personal information and details of attendants and the person receiving waiver services. This role of the EOR is vital to the safety of the individuals that are involved, and I could not think of anyone that would be able to put the best interests and care for these children further to the forefront than their parents. With that being said, expecting families to have a friend or neighbor act as an EOR (instead of a parent or guardian) forces families to disclose personal information and also takes away their right to act in their loved one’s best interests. I DMAS has stated that CMS is requiring these new ‘guardrails’ in order to continue to allow parents of minors and spouses to provide personal care. However, in recent public communications as well as emails from Directors Alissa DeBoy and Curtis Cunningham with CMS stated “CMS continues to encourage states to use the array of flexibilities allowable under existing Medicaid authorities to incorporate reimbursement of legally responsible individuals into HCBS programs on a longer-term basis. While there are no federal barriers in place, it is ultimately at the state’s discretion”. These guardrails proposed by DMAS are their proposals- and unfortunately, they place an undue burden upon families.
HB1021 - Community services boards, local; waiver usage flexibility.
HB1185 - Prescription Monitoring Program; overdose information.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
HB1455 - Virginia Memory Project; established.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
January 31, 2024 Respected House Health and Human Services - Behavioral Health Committee Members: I am writing to state my utmost support for passage of the 2024 Virginia House of Delegates Bill NO. 1455. I am most hopeful that passage of this bill will codify and underwrite the establishment of the Virginia Memory Project (VMP) as a population-based, statewide Alzheimer’s Disease and Related Disorders (ADRD) registry. I am passionate about the VMP. To be sure, national and statewide data on ADRD incidence, prevalence, and cost is chilling. More personally, as a Geriatrician, I have cared for many Virginia patients and families with ADRD. I thus have seen over and over the suffering these devastating disorders inflict. I see the VMP as a leader and a cutting edge innovation in Virginia’s battle against ADRD. In establishing the VMP, Virginia becomes only the 4th state to boast a statewide ARDR registry. Benefits are multiple, first as a means of examining ADRD distribution and determinants, and second by offering crucial insights on unmet needs for purposes of planning of medical and social services, examining ADRD-related socio-demographic disparities, and supporting ADRD research. Moreover, the VMP goes above and beyond registry” functioning as usual.” In its intentional design to allow self-reporting by ADRD caregivers and persons with undiagnosed cognition issues, it gives voice to constituencies that would otherwise be overlooked. With its linkages to education, support, and access to care, the VMP is of immediate benefit and help to its enrollees, thereby becoming the first and only “ADRD registry with a heart”. Although there is excellent return on investment, the VMP needs monetary support-for staff, consultants, infrastructure for data entry and management, structures and processes to ensure accuracy and confidentiality, and the capacity to generate accurate and timely reports. That such support would be forthcoming for the VMP via House bill 1455 would indeed be a huge win for this Commonwealth. Sincerely, Daniel Bluestein MD, MS, CMD-R, AGSF-R, Certificate Added Qualifications-Geriatrics Adjunct Professor, Virginia Geriatric Education Center/Virginia Center on Aging Virginia Commonwealth University College of Health Professions Professor Emeritus Department of Family & Community Medicine Eastern Virginia Medical School
HJ41 - Fentanyl crisis; Joint Commission on Health Care to study policy solutions.
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Alexandria is a vibrant city based on history, culture, a waterfront and lots of tourism. If Virginia has money and space to build an arena then you have money and space to build new schools. Our school system is deplorable. It’s overcrowded. Think of your citizens before thinking about your quick money grab that eventually leads to an inevitable loss. We don’t want or need an arena. This is pure greed.
HB50 - Central State Hospital; designation of additional beds as forensic and psychiatric beds.
Comments Document
HB 50 support. Currently Hiram Davis medical center Petersburg serves psychiatric and violent individuals in the same building as intellectual disabilities. Please prevent harm to defenseless Cognitive impaired. I have witnessed armed guards and sharing same hallways as intellectual disabilities populations. HB313, request amend to include Hiram Davis medical center and Sevtc Chesapeake Training Center. Equal protection and investigations for individuals with intellectual disabilities. HB 515 Oppose. Violates Olmsted Supreme Court case federal law protects choice by guardian. Lack of due process timeframe for Medicaid and Medicare recipientsm Individuals with profound intellectual disabilities cannot make their own decisions. Mental health discharges intended but remains Linked in the code section. See Olmsted and ADA federal laws. I'm a legal guardian for son Taylor Bryant at Hiram Davis medical center after displaced from CVTC. Vote No.