Lawmakers look to cut patients’ out-of-pocket prescription costs

A pair of lawmakers unveiled bipartisan legislation they say will cut out-of-pocket prescription costs for patients.

House Bill 469, sponsored by state Reps. Thomas E. West, D-Canton, and Susan Manchester, R-Waynesfield, prohibits health insurance providers from disallowing payments made through copay assistance programs to count toward a patient’s deductible.

“Copay assistance programs through drug manufacturers, charities or churches help patients with chronic, complex conditions by covering the additional cost they are required to pay for their prescription drugs,” Manchester said during a press conference announcing the legislation. “The assistance provided also counts toward a patient’s insurance deductible and coinsurance, allowing many rare-disease patients to save thousands of dollars on their prescriptions each month and to be able to meet their other medical and insurance plan costs.

“These cost-sharing programs are based on financial need and exist to help patients pay for expensive prescription drugs for which no generics typically exist,” Manchester added. “However, health insurers had begun to institute policies that prevent these co-pay assistance programs from applying toward a patient’s deductible and coinsurance.”

Lawmakers in Arizona, Illinois, Virginia and West Virginia have already passed similar, while legislators in Kentucky, Indiana and North Carolina could soon consider similar proposals, Manchester said. The lawmakers believe the proposal will have a long-lasting effect on patients with diseases such as multiple sclerosis and hemophilia, saving them thousands of dollars in prescription costs.

“This bill strives to protect patients who are being blindsided by unfair policies when learning they owe thousands of dollars because of unmet deductibles,” Manchester said.

Aaron Clark, chief pharmacy officer for Equitas Health, a regional nonprofit healthcare system, said copay accumulators, “a mechanism by which insurance companies preclude external assistance programs from counting toward a patient’s deducible or out-of-pocket maximums,” serve as a barrier for people to procure the potentially-life saving medications they need.

“Copay accumulators are not only a public health issue that affect the individual but they also affect the overall community,” Clark said.

“For patients living with life-altering conditions that often require specialty and other expensive brand-name medications, we should strive to ensure that barriers are removed, patients have access to medications they need and that the high cost of care are not shifted to those that are least able to shoulder the cost,” Clark said. “Copay accumulators are one of those barriers that we must remove, and that’s why this bill is so important.”

Proponents of the proposal note insurers often receive payment twice for the same medications. They keep the assistance payment from a manufacturer or church in addition to copays the patient makes during the deductible phase.

“The time is now for us to make a change. It’s time for us to make a difference in the state of Ohio,” West said during a press conference. “We must unite to make sure patients have access to copay assistance and all other tools they need to live healthy and productive lives right here in Ohio.”