Volume 7 Number 3 January 15, 2010

Sean M. ShawInsurance Consumer Advocate in Support of Prescription Drug Insurance Coverage Bills

Sean M. Shaw, Esq., Florida Insurance Consumer Advocate

Florida’s Insurance Consumer Advocate Sean Shaw is urging lawmakersOffice of the Insurance Consumer Advocate to ensure that Floridians have access to the most affordable and effective medications available through their health insurance policies.

On January 5, ICA Shaw sent letters to Senator Mike Fasano and Representative Denise Grimsley in support of their legislation relating to prescription drug insurance coverage (SB 516/HB 275). The legislation aims to protect consumers by limiting the ability of insurers to make immediate changes to their prescription coverage in the middle of a policy year, such as suddenly changing copayment amounts or only covering generic versions of a drug.

“It is heartbreaking to think of someone going through the process of finding an effective drug for themselves and their condition, only to have their insurance company substitute the drug with a potentially less effective generic substitute,” said ICA Shaw. “This legislation will alleviate this burden so consumers can continue to use the medication that works best for them at an affordable price.”

ICA Shaw has offered to speak on behalf of the legislation when it is presented to House and Senate committees, and has also offered to meet with Senator Fasano and Representative Grimsley to address any prospective amendments or changes to the proposed legislation.

A copy of Insurance Consumer Advocate Shaw’s letter to Senator Fasano follows:

January 5, 2010

The Honorable Mike Fasano Florida Senate 8217 Massachusetts Ave. New Port Richey, Florida 34653-3111

Dear Senator Fasano:

I would like to take this opportunity to offer the full support of the Office of the Insurance Consumer Advocate to your efforts in passing Senate Bill 516. While I have some concern that this Bill may result in increased costs of coverage, I believe it will offer much needed protection for consumers by limiting the ability of insurers to make immediate changes in their prescription formularies and their ability to do so without notice to consumers.

As drafted, this bill will help consumers who have gone through the tedious process of finding the most effective drug for them and their condition, only to have their insurer substitute a drug with a different formula that may not be as effective in their particular instance. In some cases, insurers have moved specific drugs from lower tiers to the highest copayment tier, or they have changed the formulary to make the consumer pay the copayment along with the difference in cost between the brand name drug and its generic substitute. Making changes to the formulary in the middle of the policy year places an undue burden on consumers, and it is imperative that this bill is passed so that consumers may continue to use the medication that best works for them at an affordable price. However, I am concerned about increasing the cost of coverage, and I hope that you will consider changes that may mitigate this problem.

My office has some additional ideas regarding formulary legislation that I believe could further aid consumers and would like to discuss them with you at your convenience. I would also be happy to speak in support of the bill, and I welcome the opportunity to meet with you at a mutually beneficial time.


Sean M. Shaw, Esq.

Insurance Consumer Advocate.

The Insurance Consumer Advocate is appointed by Florida Chief Financial Officer Alex Sink and is committed to finding solutions to insurance issues facing Floridians, calling attention to questionable insurance practices, promoting a viable insurance market responsive to the needs of Florida’s diverse population and assuring that rates are fair and justified.