CHANGE Act of 2023

Support for a bill to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for geriatrics workforce enhancement and academic career award programs; advancing research at the National Institute on Aging on drivers of chronic conditions and diseases common to older people, and development of effective treatments and care for such conditions and diseases including Alzheimer's disease and related dementias. Support for shared decision making, care planning and services, and primary care quality measures for Medicare beneficiaries with cognition concerns and their doctors, omitted in the CHANGE Act of 2023 (HR 4752/S 2379) and American Medical Innovation and Investment Act of 2024, HR 8816.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for primary care physician payment reform, including S.4338, "Pay PCPs Act of 2024;" incentives to attract adequate workforce, including geriatrics professionals, to care for older adults; and shared decision-making and patient-centered care on treatment plans for older adults. Support for payment for advanced primary care management (APCM) services in Medicare CY 2025 proposed physician payment rule. Support for shared decision making, care planning and services, and primary care quality measures for Medicare beneficiaries with cognition concerns and their doctors, omitted in the CHANGE Act of 2023 (HR 4752/S 2379) and American Medical Innovation and Investment Act of 2024, HR 8816.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

General issues related to Medicare and Medicaid, including: Part D Medicare Program; Part B Medicare Program; Drug Pricing; Centers for Medicare and Medicaid Services (CMS) National Coverage Determination NCD for Alzheimer's Drugs; H.R.5376, Inflation Reduction Act of 2022 (P.L.117-169) implementation; Center for Medicare and Medicaid Innovation (CMMI) Proposed Accelerated Approval Payment Policy; Center for Medicare and Medicaid Innovation (CMMI) Medicaid Proposed Rebate Rule; S. 2379 / H.R. 4752, the CHANGE Act. Issues related to intellectual property.

Client expense: $340,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to the 340B Drug Discount Program - H.R. 8574 340B ACCESS Act Issues pertaining to the implementation of the Inflation Reduction Act of 2022 Issues pertaining to Pharmacy Benefit Managers Issues pertaining to CMS Coverage of APS in LTC Alzheimers screening in Medicare - S. 2379 & H.R. 4752 - The Change Act of 2023 Issues pertaining to Medicares Six Protected Classes policy Medicare Part D Smoothing Benefit - FY 2025 Labor-HHS Appropriations Orphan drug exclusion in the Inflation Reduction Act - H.R. 5539 & S. 3131 - The ORPHAN Cures Act of 2023 Small molecule discrepancy in the Inflation Reduction Act - H.R. 7174 - The EPIC Act

Client expense: $130,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lobbying to Increase Prescription Drug Affordability and Accessibility: Advocacy for Medicare Part D redesign and benefits for people living with Parkinson's, including expanding the low-income subsidy (LIS) program, capping out-of-pocket costs, implementing a smoothing mechanism, and streamlining utilization management processes. The Medicare Part D Six Protected Classes Policy: Requires Part D plans to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to a wide range of treatment options for antidepressants and antipsychotics, which are crucial for managing non-motor symptoms like depression and psychosis. Signed Coalition Letters: - Medicare Access for Prescription Rx (MAPRx): Comment letter in response to Medicare Prescription Payment Plan Part One Guidance. - Patient and Provider Advocates for Telehealth: Comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) supporting expanded access to telehealth. - Alliance for Aging Research: Coalition letter in response to Medicare Prescription Payment Plan Part One Guidance supporting proposed beneficiary protections. H.R.4752/S.2379 - CHANGE Act of 2023: A bill to better utilize existing Medicare wellness visits for early screening, detection, and diagnosis of Alzheimer's and related dementias, including Parkinson's disease dementia. S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: A bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans used to confirm Parkinson's diagnoses, under the Medicare outpatient prospective payment system. CMS-1809-P (2025 Medicare OPPS Proposed Rule): Comment supporting CMS's proposal to separately reimburse certain diagnostic radiopharmaceuticals used in diagnosing Parkinson's disease and atypical parkinsonisms. H.R.8702/S.4532 - Improving Seniors' Timely Access to Care Act: Establishes requirements for the use of prior authorization under Medicare Advantage plans to ensure timely access to care for seniors, including those with Parkinson's. S.3109/H.R.8018 - Alleviating Barriers for Caregivers (ABC) Act: Requires the Centers for Medicare & Medicaid Services (CMS) and Social Security to simplify processes and communications for family caregivers to assist individuals in accessing and utilizing benefits. S.3766/H.R.7274 - Connecting Caregivers to Medicare Act: Amends the Social Security Act to provide outreach and education to Medicare beneficiaries and simplify access to information for family caregivers through 1-800-MEDICARE. Advocacy for Durable Medical Equipment (DME) Access: Lobbying CMS to direct Medicare contractors to clarify claims procedures for DME therapies requiring administration via external infusion pumps, ensuring quick access to new Parkinson's therapies after FDA approval.

H.R.2365/S.1064 - National Plan to End Parkinson's Act: A bill to create an advisory council comprising members of federal agencies that support research, care, and services for Parkinson's disease, as well as patients, care partners, researchers, clinicians, and other non-federal experts, to ensure efficient and effective coordination among all federal entities responsible for managing, treating, and curing Parkinson's disease. General Parkinson's Disease Information: Covers symptoms, triggers, health coverage, health costs, social determinants of health, data collection, research, environmental risks, and health access for underserved communities, particularly through the CDC's National Neurological Conditions Surveillance System (NNCSS). H.R.2630/S.652/S.1339 - Safe Step Act: Requires group health plans to provide an exception process for any medication step therapy protocol to ensure that individuals living with Parkinson's disease can access treatments safely and efficiently. Establishing Parkinson's Disease ICD-10-CM Codes: Aims to assist in the coordination of care for Parkinson's patients who experience OFF episodes and to allow researchers to gather data to study disease progression. S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: A bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans, which aid in confirming a Parkinson's diagnosis under the Medicare prospective payment system for hospital outpatient services. H.R.3432 - Telemental Health Care Access Act of 2023: Permanently removes Medicare's originating site requirements for mental health services furnished via telehealth. Parkinson's non-motor symptoms include mental health conditions, and many people with Parkinson's are Medicare beneficiaries who may face barriers due to in-person requirements. H.R.830/S.1375 - Help Ensure Lower Patient Copays Act: A bill requiring health insurance plans to apply certain payments, including third-party payments, financial assistance, and product vouchers, toward a plan's cost-sharing requirements. This helps Parkinson's patients afford medications for managing symptoms. The Medicare Part D Six Protected Classes Policy: Requires Part D plans to cover all drugs in six protected classes, including antidepressants and antipsychotics. For individuals with Parkinson's disease, these medications are crucial for managing non-motor symptoms such as depression and psychosis. H.R.4752/S.2379 - CHANGE Act of 2023: A bill to improve early screening, detection, and diagnosis of Alzheimer's and related dementias, including Parkinson's disease dementia, during Medicare wellness visits. H.R.4942/S.655 - Conrad State 30 and Physician Access Reauthorization Act: Reauthorizes the Conrad State 30 program and improves policies to address health care provider shortages, supporting neurological care for Parkinson's patients. H.R.8702/S.4532 - Improving Seniors Timely Access to Care Act: Establishes requirements regarding the use of prior authorization under Medicare Advantage plans. H.R.9233/S.- The HEALTHY Brains Act: Draft legislation to create a Centers of Excellence grant program within the National Institutes of Health to focus on the intersection between environmental risk factors and neurodegenerative diseases. General Outreach for Establishing an ""Office of Caregiver Health"": Supports the creation of an Office of Caregiver Health within the Department of Health and Human Services to address the needs of caregivers, particularly in relation to Parkinson's disease care.

Support for primary care physician payment reform, including S.4338, "Pay PCPs Act of 2024;" incentives to attract adequate workforce, including geriatrics professionals, to care for older adults; and shared decision-making and patient-centered care on treatment plans for older adults. Support for payment for advanced primary care management (APCM) services in Medicare CY 2025 proposed physician payment rule. Support for shared decision making and care planning and services, and primary care quality measures, for Medicare beneficiaries with cognition concerns and their doctors, omitted in the CHANGE Act of 2023 (HR 4752/S 2379)/American Medical Innovation and Investment Act of 2024, HR 8816.

Client expense: Not reported · Firm income: $20,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for a bill to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lobbying to increase prescription drug affordability and accessibility for people living with Parkinson's via Medicare Part D redesign and benefits, including expanding the low-income subsidy (LIS) program, capping out-of-pocket costs, implementing a smoothing mechanism, and streamlining utilization management processes. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Partnership for Part D Access coalition congressional meetings and signed coalition letter to CMS in response to Medicare Prescription Payment Plan Part One Guidance in support of continued protection for the six protected classes policy. Signed Medicare Access for Prescription Rx (MAPRx) coalition comment letter in response to Medicare Prescription Payment Plan Part One Guidance. Signed Patient and Provider Advocates for Telehealth coalition comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) in support prioritizing the needs of patients by expanding policies that improved access to safe and timely health care via telehealth. Signed Alliance for Aging Research coalition letter in response to Medicare Prescription Payment Plan Part One Guidance in support of proposed beneficiary protections and to provide feedback on implementation considerations for the Medicare Prescription Payment Plan program. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. Signed Leaders Engaged on Alzheimer's Disease (LEAD) Coalition letter to members of Congress in support of this legislation. S. 3109- Alleviating Barriers for Caregivers (ABC) Act- bill to require the Administrator of the Centers for Medicare & Medicaid Services and the Commissioner of Social Security to review and simplify the processes, procedures, forms, and communications for family caregivers to assist individuals in establishing eligibility for, enrolling in, and maintaining and utilizing coverage and benefits under the Medicare, Medicaid, CHIP, and Social Security programs respectively, and for other purposes. Lobbying the Centers for Medicare and Medicaid Services to direct Durable Medical Equipment Medicare Administrative Contractors to provide additional clarification regarding the use of claim modifiers for DME therapies that require administration via an external infusion pump to expedite patient access once new Parkinson's therapies receive approvals from the Food and Drug Administration. S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: a bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans, which can aid in confirming a Parkinson's diagnosis, under the Medicare prospective payment system for hospital outpatient department services. S. 3766/H.R. 7274- Connecting Caregivers to Medicare Act -To amend title XVIII of the Social Security Act to provide for outreach and education to Medicare beneficiaries to simplify access to information for family caregivers through 1-800-MEDICARE, and for other purposes. H.R. 8018/S. 3109- Alleviating Barriers for Caregivers (ABC) Act- bill to require the Administrator of the Centers for Medicare & Medicaid Services and the Commissioner of Social Security to review and simplify the processes, procedures, forms, and communications for family caregivers to assist individuals in establishing eligibility for, enrolling in, and maintaining and utilizing coverage and benefits under the Medicare, Medicaid, CHIP, and Social Security programs respectively, and for other purposes. H.R.8702/S.4532 - Improving Seniors Timely Access to Care Act: a bill to establish requirements with respect to the use of prior authorization under Medicare Advantage plans.

H.R.2365/S.1064 - National Plan to End Parkinson's Act: a bill to create an advisory council comprising members of federal agencies that support research, care, and services for Parkinsons, plus patients, care partners, researchers, clinicians, and other non-federal experts to ensure efficient and effective coordination among all federal entities with responsibility for managing, treating, and curing Parkinsons disease. General Parkinson's disease information about symptoms, triggers, health coverage, health costs, social determinants of health related to Parkinson's disease and data collection, research, environmental risks, and health access for underserved communities. Information related to prevalence particularly at CDC's National Neurological Conditions Surveillance System (NNCSS). H.R.2630/S.652/S.1339 - Safe Step Act: a bill to require group health plans to provide an exception process for any medication step therapy protocol to help ensure that people living with Parkinson's disease can safely and efficiently access treatments. Establishing Parkinson's disease ICD-10-CM codes to assist in the continuation and coordination of care for people living with Parkinson's who experience OFF episodes and to allow researchers to gather more data to study the progression of the disease. Reauthorization of CDCs National Neurological Conditions Surveillance System (NNCSS). S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: a bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans, which can aid in confirming a Parkinson's diagnosis, under the Medicare prospective payment system for hospital outpatient department services. H.R.3432 - Telemental Health Care Access Act of 2023: a bill to permanently remove Medicare's originating site requirements for mental health services furnished via telehealth. Parkinson's non-motor symptoms encompass mental health conditions, including anxiety, depression, dementia, and other memory problems, and the majority of people living with Parkinson's in the United States are Medicare beneficiaries, many of whom will face undue burdens meeting the unnecessary in-person requirement for telemental health services after the delay of the requirement enforcement expires December 31, 2024. H.R.830/S.1375 - Help Ensure Lower Patient Copays Act: a bill to require health insurance plans to apply certain payments made by, or on behalf of, a plan enrollee toward a plan's cost-sharing requirements. Specifically, plans must apply third-party payments, financial assistance, discounts, product vouchers, and other reductions in out-of-pocket expenses toward the requirements. Many Parkinson's patients rely on such third-party payments to afford medications to treat and manage their disease symptoms, and this legislation will ensure that all payments whether they come directly out of a pocket or with the help of copay assistance-counts toward out-of-pocket costs of patients. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. Signed Leaders Engaged on Alzheimer's Disease (LEAD) Coalition letter to members of Congress in support of this legislation. H.R.4942/S.655 - the Conrad State 30 and Physician Access Reauthorization Act: a bill to reauthorize the Conrad State 30 program for three years, make several targeted policy improvements, and permit the gradual expansion of the number of waivers granted to each state to address health care provider shortages. Signed American Academy of Neurology letter to member of Congress in support of this legislation. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Partnership for Part D Access coalition congressional meetings and signed coalition letter to CMS in response to Medicare Prescription Payment Plan Part One Guidance in support of continued protection for the six protected classes policy. Signed Medicare Access for Prescription Rx (MAPRx) coalition comment letter in response to Medicare Prescription Payment Plan Part One Guidance. Signed Patient and Provider Advocates for Telehealth coalition comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) in support prioritizing the needs of patients by expanding policies that improved access to safe and timely health care via telehealth. Signed Alliance for Aging Research coalition letter in response to Medicare Prescription Payment Plan Part One Guidance in support of proposed beneficiary protections and to provide feedback on implementation considerations for the Medicare Prescription Payment Plan program. H.R.8702/S.4532 - Improving Seniors Timely Access to Care Act: a bill to establish requirements with respect to the use of prior authorization under Medicare Advantage plans. H.R./S.- The HEALTHY Brains Act- draft legislation to create a Centers of Excellence grant program within the National Institute of Health to focus on the intersection between environmental risk factors and neurodegenerative disease. General outreach and support for the establishment of an "Office of Caregiver Health" within the Office of the Secretary at the Department of Health and Human Services.

Issues pertaining to the 340B Drug Discount Program - H.R. 8574 340B ACCESS Act Issues pertaining to the implementation of the Inflation Reduction Act of 2022 Issues pertaining to Pharmacy Benefit Managers Issues pertaining to CMS Coverage of APS in LTC Alzheimers screening in Medicare - S. 2379 & H.R. 4752 - The Change Act of 2023 Issues pertaining to Medicares Six Protected Classes policy Medicare Part D Smoothing Benefit - FY 2025 Labor-HHS Appropriations Orphan drug exclusion in the Inflation Reduction Act - H.R. 5539 & S. 3131 - The ORPHAN Cures Act of 2023 Small molecule discrepancy in the Inflation Reduction Act - H.R. 7174 - The EPIC Act

Client expense: $140,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Support for a bill to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to the 340B Drug Discount Program Issues pertaining to the implementation of the Inflation Reduction Act of 2022 EPIC Act (no bill number) Issues pertaining to Pharmacy Benefit Managers Issues pertaining to CMS Coverage of APS in LTC Alzheimers screening in Medicare - S. 2379 & H.R. 4752 - The Change Act of 2023 Issues pertaining to Medicares Six Protected Classes policy

Client expense: $130,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lobbying to increase prescription drug affordability and accessibility for people living with Parkinson's via Medicare Part D redesign and benefits, including expanding the low-income subsidy (LIS) program, capping out-of-pocket costs, implementing a smoothing mechanism, and streamlining utilization management processes. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Lobbying the Centers for Medicare and Medicaid Services to direct Durable Medical Equipment Medicare Administrative Contractors to provide additional clarification regarding the use of claim modifiers for DME therapies that require administration via an external infusion pump to expedite patient access once new Parkinson's therapies receive approvals from the Food and Drug Administration. S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: a bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans, which can aid in confirming a Parkinson's diagnosis, under the Medicare prospective payment system for hospital outpatient department services. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. S. 3109- Alleviating Barriers for Caregivers (ABC) Act- bill to require the Administrator of the Centers for Medicare & Medicaid Services and the Commissioner of Social Security to review and simplify the processes, procedures, forms, and communications for family caregivers to assist individuals in establishing eligibility for, enrolling in, and maintaining and utilizing coverage and benefits under the Medicare, Medicaid, CHIP, and Social Security programs respectively, and for other purposes. S. 3766/H.R. 7274- Connecting Caregivers to Medicare Act -To amend title XVIII of the Social Security Act to provide for outreach and education to Medicare beneficiaries to simplify access to information for family caregivers through 1-800-MEDICARE, and for other purposes.

H.R.2365/S.1064 - National Plan to End Parkinson's Act: a bill to create an advisory council comprising members of federal agencies that support research, care, and services for Parkinsons, plus patients, care partners, researchers, clinicians, and other non-federal experts to ensure efficient and effective coordination among all federal entities with responsibility for managing, treating, and curing Parkinsons disease. General Parkinson's disease information about symptoms, triggers, health coverage, health costs, social determinants of health related to Parkinson's disease and data collection, research, environmental risks, and health access for underserved communities. Information related to prevalence particularly at CDC's National Neurological Conditions Surveillance System (NNCSS). H.R.2630/S.652/S.1339 - Safe Step Act: a bill to require group health plans to provide an exception process for any medication step therapy protocol to help ensure that people living with Parkinson's disease can safely and efficiently access treatments. Establishing Parkinson's disease ICD-10-CM codes to assist in the continuation and coordination of care for people living with Parkinson's who experience OFF episodes and to allow researchers to gather more data to study the progression of the disease. Reauthorization of CDCs National Neurological Conditions Surveillance System (NNCSS). S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: a bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans, which can aid in confirming a Parkinson's diagnosis, under the Medicare prospective payment system for hospital outpatient department services. H.R.3432 - Telemental Health Care Access Act of 2023: a bill to permanently remove Medicare's originating site requirements for mental health services furnished via telehealth. Parkinson's non-motor symptoms encompass mental health conditions, including anxiety, depression, dementia, and other memory problems, and the majority of people living with Parkinson's in the United States are Medicare beneficiaries, many of whom will face undue burdens meeting the unnecessary in-person requirement for telemental health services after the delay of the requirement enforcement expires December 31, 2024. H.R.830/S.1375 - Help Ensure Lower Patient Copays Act: a bill to require health insurance plans to apply certain payments made by, or on behalf of, a plan enrollee toward a plan's cost-sharing requirements. Specifically, plans must apply third-party payments, financial assistance, discounts, product vouchers, and other reductions in out-of-pocket expenses toward the requirements. Many Parkinson's patients rely on such third-party payments to afford medications to treat and manage their disease symptoms, and this legislation will ensure that all payments whether they come directly out of a pocket or with the help of copay assistance-counts toward out-of-pocket costs of patients. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. Signed Leaders Engaged on Alzheimer's Disease (LEAD) Coalition letter to members of Congress in support of this legislation. H.R.4942/S.655 - the Conrad State 30 and Physician Access Reauthorization Act: a bill to reauthorize the Conrad State 30 program for three years, make several targeted policy improvements, and permit the gradual expansion of the number of waivers granted to each state to address health care provider shortages. Signed American Academy of Neurology letter to member of Congress in support of this legislation. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Partnership for Part D Access coalition congressional meetings and signed coalition letter to CMS in response to Medicare Prescription Payment Plan Part One Guidance in support of continued protection for the six protected classes policy. Signed Medicare Access for Prescription Rx (MAPRx) coalition comment letter in response to Medicare Prescription Payment Plan Part One Guidance. Signed Patient and Provider Advocates for Telehealth coalition comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) in support prioritizing the needs of patients by expanding policies that improved access to safe and timely health care via telehealth. Signed Alliance for Aging Research coalition letter in response to Medicare Prescription Payment Plan Part One Guidance in support of proposed beneficiary protections and to provide feedback on implementation considerations for the Medicare Prescription Payment Plan program.

Support for a bill to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to the 340B Drug Discount Program Issues pertaining to the implementation of the Inflation Reduction Act of 2022 Issues pertaining to Pharmacy Benefit Managers Issues pertaining to CMS Coverage of APS in LTC Alzheimers screening in Medicare - S. 2379 & H.R. 4752 - The Change Act of 2023 Issues pertaining to Medicares Six Protected Classes policy

Client expense: $100,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R.2365/S.1064 - National Plan to End Parkinson's Act: a bill to create an advisory council comprising members of federal agencies that support research, care, and services for Parkinsons, plus patients, care partners, researchers, clinicians, and other non-federal experts to ensure efficient and effective coordination among all federal entities with responsibility for managing, treating, and curing Parkinsons disease. General Parkinson's disease information about symptoms, triggers, health coverage, health costs, social determinants of health related to Parkinson's disease and data collection, research, environmental risks, and health access for underserved communities. Information related to prevalence particularly at CDC's National Neurological Conditions Surveillance System (NNCSS). S.652/S.1339 - Safe Step Act: a bill to require group health plans to provide an exception process for any medication step therapy protocol to help ensure that people living with Parkinson's disease can safely and efficiently access treatments. Establishing Parkinson's disease ICD-10-CM codes to assist in the continuation and coordination of care for people living with Parkinson's who experience OFF episodes and to allow researchers to gather more data to study the progression of the disease. Reauthorization of CDCs National Neurological Conditions Surveillance System (NNCSS). S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: a bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans, which can aid in confirming a Parkinson's diagnosis, under the Medicare prospective payment system for hospital outpatient department services. H.R.3432 - Telemental Health Care Access Act of 2023: a bill to permanently remove Medicare's originating site requirements for mental health services furnished via telehealth. Parkinson's non-motor symptoms encompass mental health conditions, including anxiety, depression, dementia, and other memory problems, and the majority of people living with Parkinson's in the United States are Medicare beneficiaries, many of whom will face undue burdens meeting the unnecessary in-person requirement for telemental health services after the delay of the requirement enforcement expires December 31, 2024. H.R.830/S.1375 - Help Ensure Lower Patient Copays Act: a bill to require health insurance plans to apply certain payments made by, or on behalf of, a plan enrollee toward a plan's cost-sharing requirements. Specifically, plans must apply third-party payments, financial assistance, discounts, product vouchers, and other reductions in out-of-pocket expenses toward the requirements. Many Parkinson's patients rely on such third-party payments to afford medications to treat and manage their disease symptoms, and this legislation will ensure that all payments whether they come directly out of a pocket or with the help of copay assistance-counts toward out-of-pocket costs of patients. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. Signed Leaders Engaged on Alzheimer's Disease (LEAD) Coalition letter to members of Congress in support of this legislation. H.R.4942/S.655 - the Conrad State 30 and Physician Access Reauthorization Act: a bill to reauthorize the Conrad State 30 program for three years, make several targeted policy improvements, and permit the gradual expansion of the number of waivers granted to each state to address health care provider shortages. Signed American Academy of Neurology letter to member of Congress in support of this legislation. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Partnership for Part D Access coalition congressional meetings and signed coalition letter to CMS in response to Medicare Prescription Payment Plan Part One Guidance in support of continued protection for the six protected classes policy. Signed Medicare Access for Prescription Rx (MAPRx) coalition comment letter in response to Medicare Prescription Payment Plan Part One Guidance. Signed Patient and Provider Advocates for Telehealth coalition comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) in support prioritizing the needs of patients by expanding policies that improved access to safe and timely health care via telehealth. Signed Alliance for Aging Research coalition letter in response to Medicare Prescription Payment Plan Part One Guidance in support of proposed beneficiary protections and to provide feedback on implementation considerations for the Medicare Prescription Payment Plan program.

Lobbying to increase prescription drug affordability and accessibility for people living with Parkinson's via Medicare Part D redesign and benefits, including expanding the low-income subsidy (LIS) program, capping out-of-pocket costs, implementing a smoothing mechanism, and streamlining utilization management processes. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Partnership for Part D Access coalition congressional meetings and signed coalition letter to CMS in response to Medicare Prescription Payment Plan Part One Guidance in support of continued protection for the six protected classes policy. Signed Medicare Access for Prescription Rx (MAPRx) coalition comment letter in response to Medicare Prescription Payment Plan Part One Guidance. Signed Patient and Provider Advocates for Telehealth coalition comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) in support prioritizing the needs of patients by expanding policies that improved access to safe and timely health care via telehealth. Signed Alliance for Aging Research coalition letter in response to Medicare Prescription Payment Plan Part One Guidance in support of proposed beneficiary protections and to provide feedback on implementation considerations for the Medicare Prescription Payment Plan program. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. Signed Leaders Engaged on Alzheimer's Disease (LEAD) Coalition letter to members of Congress in support of this legislation. S. 3109- Alleviating Barriers for Caregivers (ABC) Act- bill to require the Administrator of the Centers for Medicare & Medicaid Services and the Commissioner of Social Security to review and simplify the processes, procedures, forms, and communications for family caregivers to assist individuals in establishing eligibility for, enrolling in, and maintaining and utilizing coverage and benefits under the Medicare, Medicaid, CHIP, and Social Security programs respectively, and for other purposes.

Bill introduction to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Bill introduction to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Bill introduction to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Issues pertaining to the 340B Drug Discount Program Issues pertaining to the implementation of the Inflation Reduction Act of 2022 Issues pertaining to Pharmacy Benefit Managers Issues pertaining to CMS Coverage of APS in LTC Alzheimers screening in Medicare - S. 2379 & H.R. 4752 - The Change Act of 2023 Issues pertaining to Medicares Six Protected Classes policy

Client expense: $160,000 · Firm income: Not reported

Government targets: HOUSE OF REPRESENTATIVES, SENATE

Lobbying to increase prescription drug affordability and accessibility for people living with Parkinson's via Medicare Part D redesign and benefits, including expanding the low-income subsidy (LIS) program, capping out-of-pocket costs, implementing a smoothing mechanism, and streamlining utilization management processes. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Partnership for Part D Access coalition congressional meetings and signed coalition letter to CMS in response to Medicare Prescription Payment Plan Part One Guidance in support of continued protection for the six protected classes policy. Signed Medicare Access for Prescription Rx (MAPRx) coalition comment letter in response to Medicare Prescription Payment Plan Part One Guidance. Signed Patient and Provider Advocates for Telehealth coalition comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) in support prioritizing the needs of patients by expanding policies that improved access to safe and timely health care via telehealth. Signed Alliance for Aging Research coalition letter in response to Medicare Prescription Payment Plan Part One Guidance in support of proposed beneficiary protections and to provide feedback on implementation considerations for the Medicare Prescription Payment Plan program. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. Signed Leaders Engaged on Alzheimer's Disease (LEAD) Coalition letter to members of Congress in support of this legislation.

H.R.2365/S.1064 - National Plan to End Parkinson's Act: a bill to create an advisory council comprising members of federal agencies that support research, care, and services for Parkinsons, plus patients, care partners, researchers, clinicians, and other non-federal experts to ensure efficient and effective coordination among all federal entities with responsibility for managing, treating, and curing Parkinsons disease. General Parkinson's disease information about symptoms, triggers, health coverage, health costs, social determinants of health related to Parkinson's disease and data collection, research, environmental risks, and health access for underserved communities. Information related to prevalence particularly at CDC's National Neurological Conditions Surveillance System (NNCSS). S.652/S.1339 - Safe Step Act: a bill to require group health plans to provide an exception process for any medication step therapy protocol to help ensure that people living with Parkinson's disease can safely and efficiently access treatments. Establishing Parkinson's disease ICD-10-CM codes to assist in the continuation and coordination of care for people living with Parkinson's who experience OFF episodes and to allow researchers to gather more data to study the progression of the disease. Reauthorization of CDCs National Neurological Conditions Surveillance System (NNCSS). S.1544/H.R.1199 - Facilitating Innovative Nuclear Diagnostics Act of 2023: a bill to establish separate payment requirements for diagnostic radiopharmaceuticals, including DaTscans, which can aid in confirming a Parkinson's diagnosis, under the Medicare prospective payment system for hospital outpatient department services. H.R.3432 - Telemental Health Care Access Act of 2023: a bill to permanently remove Medicare's originating site requirements for mental health services furnished via telehealth. Parkinson's non-motor symptoms encompass mental health conditions, including anxiety, depression, dementia, and other memory problems, and the majority of people living with Parkinson's in the United States are Medicare beneficiaries, many of whom will face undue burdens meeting the unnecessary in-person requirement for telemental health services after the delay of the requirement enforcement expires December 31, 2024. H.R.830/S.1375 - Help Ensure Lower Patient Copays Act: a bill to require health insurance plans to apply certain payments made by, or on behalf of, a plan enrollee toward a plan's cost-sharing requirements. Specifically, plans must apply third-party payments, financial assistance, discounts, product vouchers, and other reductions in out-of-pocket expenses toward the requirements. Many Parkinson's patients rely on such third-party payments to afford medications to treat and manage their disease symptoms, and this legislation will ensure that all payments whether they come directly out of a pocket or with the help of copay assistance-counts toward out-of-pocket costs of patients. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. H.R.4752/S.2379 - the Concentrating High-value Alzheimer's Needs to Get to an End (CHANGE) Act of 2023: a bill to better utilize the existing Welcome to Medicare initial exam and Medicare annual wellness visits to screen, detect, and diagnose Alzheimers and related dementias, including Parkinson's disease dementia, in their earliest stages. Signed Leaders Engaged on Alzheimer's Disease (LEAD) Coalition letter to members of Congress in support of this legislation. H.R.4942/S.655 - the Conrad State 30 and Physician Access Reauthorization Act: a bill to reauthorize the Conrad State 30 program for three years, make several targeted policy improvements, and permit the gradual expansion of the number of waivers granted to each state to address health care provider shortages. Signed American Academy of Neurology letter to member of Congress in support of this legislation. The Medicare Part D Six Protected Classes Policy: requires Part D plan to cover all drugs in six classes: immunosuppressants, antidepressants, antipsychotics, anticonvulsants, antiretrovirals, and antineoplastics. For people living with Parkinson's, most of whom are Medicare beneficiaries, it is essential to have access to wide range of treatment options for antidepressants and antipsychotics. Parkinson's causes non-motor symptoms, including depression and psychosis, and individuals often experience different side effects, reactions, and efficacy based on which medications they take. Partnership for Part D Access coalition congressional meetings and signed coalition letter to CMS in response to Medicare Prescription Payment Plan Part One Guidance in support of continued protection for the six protected classes policy. Signed Medicare Access for Prescription Rx (MAPRx) coalition comment letter in response to Medicare Prescription Payment Plan Part One Guidance. Signed Patient and Provider Advocates for Telehealth coalition comment letter in response to CMS CY 2024 Medicare Physician Fee Schedule (PFS) in support prioritizing the needs of patients by expanding policies that improved access to safe and timely health care via telehealth. Signed Alliance for Aging Research coalition letter in response to Medicare Prescription Payment Plan Part One Guidance in support of proposed beneficiary protections and to provide feedback on implementation considerations for the Medicare Prescription Payment Plan program.

Bill introduction to use a cognitive assessment tool in the Medicare annual prevention visit - The CHANGE Act (HR 4752/S 2379); appropriations for NIH, HRSA, and CDC.

Client expense: Not reported · Firm income: $10,000

Government targets: HOUSE OF REPRESENTATIVES, SENATE

H.R. 547/ S. 100, Better Care Better Jobs Act H.R. 1113/S. 423, Easy Enrollment in Health Care Act H.R. 1535, Eliminating Backlogs Act H.R. 1637/S. 626, Comprehensive Care for Alzheimers Act H.R. 1770/S. 2477, Equitable Community Access to Pharmacist Services Act H.R. 2377/S. 1000, Saving Access to Laboratory Services Act H.R. 2389/ S. 1302, Resident Physician Shortage Reduction Act H.R. 2411/S. 1150, National Nursing Workforce Center Act H.R. 2559, Strengthening Community Care Act H.R. 3069/S. 1296, John Lewis Equality in Medicare and Medicaid Treatment Act H.R. 3799, Custom Health Option and Individual Care Expense Arrangement Act H.R. 4752/S. 2379, Concentrating on High-Value Alzheimers Needs to Get to an End (CHANGE) Act H.R. 5013, Value in Health Care Act H.R. 5687, HSA Modernization Act H.R. 5688, Bipartisan HAS Improvement Act H.R. 5819/ S. 1378, Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act S. 2666, Electronic Prescribing of Controlled Substances Act

Client expense: $120,000 · Firm income: Not reported

H.R. 547/ S. 100, Better Care Better Jobs Act H.R. 1113/S. 423, Easy Enrollment in Health Care Act H.R. 1535, Eliminating Backlogs Act H.R. 1637/S. 626, Comprehensive Care for Alzheimers Act H.R. 1770/S. 2477, Equitable Community Access to Pharmacist Services Act H.R. 2377/S. 1000, Saving Access to Laboratory Services Act H.R. 2389/ S. 1302, Resident Physician Shortage Reduction Act H.R. 2411/S. 1150, National Nursing Workforce Center Act H.R. 2559, Strengthening Community Care Act H.R. 3069/S. 1296, John Lewis Equality in Medicare and Medicaid Treatment Act H.R. 3799, Custom Health Option and Individual Care Expense Arrangement Act H.R. 4752/S. 2379, Concentrating on High-Value Alzheimers Needs to Get to an End (CHANGE) Act H.R. 5013, Value in Health Care Act H.R. 5687, HSA Modernization Act H.R. 5688, Bipartisan HAS Improvement Act H.R. 5819/ S. 1378, Connecting Our Medical Providers with Links to Expand Tailored and Effective (COMPLETE) Care Act S. 2666, Electronic Prescribing of Controlled Substances Act

Client expense: $120,000 · Firm income: Not reported