Legislation Introduced by Representatives McEachin and Davis Would Eliminate Harmful and Misleading Health Plan Pricing Schemes and Protect Vulnerable Patients.
The All Copays Count Coalition, which comprises more than 60 groups representing patients with serious and chronic diseases, applauds the introduction of the Help Ensure Lower Patient Copays Act (HELP Copays Act), sponsored by Representatives Donald McEachin (D-VA), Rodney Davis (R-IL), Bonnie Watson Coleman (D-NJ), Bobby Rush (D-IL), Brian Fitzpatrick (R-PA), Yvette Clarke (D-NY), Marc Veasey (D-TX), Buddy Carter (R-GA), and Barbara Lee (D-CA).
The legislation is a two-part solution that eliminates barriers to treatment for some of the most vulnerable patients—those who live with serious, complex chronic illness—ensuring that they can afford the necessary and life-saving medications prescribed by their doctors. The bipartisan HELP Copays Act requires health plans to count the value of copay assistance toward patient cost-sharing requirements. This would bring much-needed relief to financially vulnerable patients by ensuring that all payments—whether they come directly out of a patient’s pocket or with the help of copay assistance—count towards their out-of-pocket costs.
“Health plans have changed the rules on how they count copay assistance programs and have found ways to limit protections for coverage of medicines. This legislation recognizes the bipartisan consensus that people with pre-existing conditions must be protected from insurance practices that target and discriminate against them,” said National Hemophilia Foundation Senior Director of Payer Relations Kollet Koulianos. “The HELP Copays Act is a bipartisan solution that will help already vulnerable patients afford medically necessary prescription drugs.”
“High out-of-pocket costs for health care are always challenging for patients to pay, but the economic devastation caused by the pandemic has stretched too many families to the breaking point. And it has shown how important it is for people with underlying conditions to be able to get the treatment they need to stay healthy,” said The AIDS Institute Deputy Executive Director Rachel Klein. “This bipartisan legislation is needed to stop insurers from charging vulnerable patients twice for the same medication and forcing people to forego needed medication or other necessities to pay for the medicine they or their family members need.”
People living with serious, chronic health conditions often face multiple barriers to the therapies they need to treat their conditions, such as administrative hurdles like prior authorization and step therapy that limit access to specialty medications. And once approved, patients face skyrocketing deductibles and steep cost-sharing. With no other options to afford the medicine they need, many patients turn to charitable or manufacturer copay assistance to afford their drugs.
But now, many are faced with unexpected bills of thousands of dollars because their insurance plan will not count the copay assistance they get toward their annual deductible or out-of-pocket maximum. A recent survey conducted by the National Hemophilia Foundation, in conjunction with the Arthritis Foundation, Autoimmune Association and the American Kidney Fund, found that 69% of those who depend on such assistance make less than $40,000 a year, leaving the most financially vulnerable patients at risk of losing access to necessary health care.
In addition, a loophole under the Affordable Care Act allows many employer health plans to deem certain categories of prescription drugs as “non-essential,” even when they are life-saving or necessary for people with serious pre-existing and chronic conditions. When a covered drug is deemed “non-essential,” the insurer will not count any cost-sharing toward the patient’s deductible and out-of-pocket maximum—allowing big companies to avoid paying for critical care for patients who need it most.
Together, these practices undermine coverage for pre-existing conditions, hurt patient access to medicines, decrease drug adherence, and even cost our health care system more money.
Representatives McEachin, Davis, and more than 50 other lawmakers encouraged President Biden this past March to protect individuals from copay accumulator policies that hit both brand and generic treatments by asking the Centers for Medicare & Medicaid Services to reverse the previous administration’s Notice of Benefit and Payment Parameters.
The All Copays Count Coalition remains grateful for bipartisan support of policies that protect patient access to affordable medications and for the 12 states and Puerto Rico for taking legislative action to protect vulnerable people from these misleading insurance policies.
Source: National Hemophilia Foundation