Advocacy in Washington, D.C.

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State Fact Sheet
Find out how arthritis affects people in Washington D.C. and what you can do to make a difference

State of Your Health 
If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. Please be sure to view our Washington D.C. Department of Insurance fact sheet that gives instructions on how to appeal, request an external review or file a complaint with your insurance commissioner.

New Law: Out of Pocket Cost Reform in Washington, DC 

What  are  out of pocket costs?   

Insurers often place expensive drugs like biologics on specialty tiers, requiring you to pay a percentage of the cost (sometimes as much as 50 percent) rather than a fixed-dollar copay.  This can cause a patient to reach their annual out-of-pocket spending cap in the first few months of the plan year, a significant financial burden for many patients.  

How does this new law address step therapy in  Washington DC?  

In 2017, Washington DC passed legislation to address out of pocket cap costs  and the law went into effect in 2018.  This new law caps specialty drug copayment or co-insurance out-of-pocket costs to no more than $150 for up to a 30-day supply, or $300 for a 90-day supply   

Which patients will benefit from this new law?  

This law will decrease out of pocket cost to patient and gives patient right to request a non-preferred drug to be covered under the same cost sharing applicable to preferred drugs if physician determines that preferred drug would not be as effective or would have adverse effects or both.  To learn if you are covered, contact your insurer and provide your policy number.    

What should I do if I experience this barrier to care in  Washington DC?  

If you are experiencing a barrier to care, you should contact your insurance commissioner, who can help address your situation. You can easily find instructions on how to appeal, request an external review, or file a complaint to your Insurance Commissioner with our Department of Insurance one pager, click here to learn more. 

• Learn more about how the law affects  Washington, D.C.  by watching this short video 

• View or download the video slides 

• View and print our easy to use handout explaining the impact of the new law