Dear Honorable Members of the Assembly Financial Institutions and Insurance Committee,
On behalf of the nearly 750 people living with cystic fibrosis (CF) in New Jersey, we write to express our support for A4275, which requires Medicaid, the State Health Benefits Program (SHBP), and the School Employees' Health Benefits Program (SEHBP) to honor coverage decisions for maintenance medications for chronic conditions when there is a change in health benefits plan or pharmacy benefit manager (PBM). Coverage denials due to administrative changes can delay access to critical CF therapies and the Cystic Fibrosis Foundation supports efforts to protect patients from gaps in coverage and delays in care.
About Cystic Fibrosis
Cystic fibrosis is a progressive, genetic disease that affects the lungs, pancreas, and other organs. There are close to 40,000 children and adults living with cystic fibrosis in the United States, and CF can affect people of every racial and ethnic group. CF causes the body to produce thick, sticky mucus that clogs the lungs and digestive system, which can lead to life-threatening infections. CF care is grounded in evidence-based clinical guidelines and as a complex, multi-system disease without a cure, CF requires an intensive treatment regimen including multiple medications. For people with CF, it is not uncommon to take seven therapies every day, and as many as twenty. Many medications are taken year after year, and in most cases, for life. While advances in CF care are helping people live longer, healthier lives, we also know that the cost of care and administrative burden are barriers for many people with the disease.
Continuity of Care
Recognizing that people living with CF and other lifelong, chronic diseases take the same drugs for most of their lives, we appreciate that A4275 protects patients who take maintenance medications to treat their chronic conditions by requiring Medicaid, SHBP, and SEHBP to cover these treatments when there is a change in health benefits plan or PBM. Because CF is a progressive disease, patients who delay or forgo treatment — even for as little as a few days — face increased risk of lung exacerbations, costly hospitalizations, and potentially irreversible lung damage. Requiring continuity of coverage during health plan or PBM transitions will help promote immediate and consistent access to life-saving therapies for people with CF. We support efforts to reduce delays in care and ensure people have timely access to their necessary medications.
The Cystic Fibrosis Foundation supports A4275 to ensure continuity of care for patients enrolled in Medicaid, SHBP, or SEHBP plans.