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Patient-Doc Task Force Building Legal Case Against Alternative Funding Programs

 
• By Sarah Karlin-Smith

From illegal importation under FDCA to possible ERISA, HIPAA and ACA violations – a task force led by CancerCare is pushing regulatory agencies with levers to go after employer plans use of alternative funding programs for specialty drugs, which they say violate multiple federal laws. 

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Task force is building a multi-layered case against alternative funding programs that alter specialty drug coverage • Source: Shutterstock

A task force of more than a dozen groups representing patients, doctors and a variety of disease areas – many of whom receive pharma industry support – is aiming to build a legal case against alternative funding programs that they hope will convince federal regulators, particularly the US Department of Labor, to quash the use of this tactic for specialty drug coverage.

Alternative funding programs (AFPs) are a relatively new strategy employed mostly by self-funded employer plans, whereby the plans carve out or automatically deny prior authorization for certain specialty drugs and...

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