Sen. Heather Sanborn, D-Portland, has introduced a bill to prohibit insurers from implementing copay accumulator programs. LD 1783, “An Act To Require Health Insurance Carriers and Pharmacy Benefits Managers To Appropriately Account for Cost-sharing Amounts Paid on Behalf of Insureds,” was the subject of a public hearing before the Legislature’s Joint Standing Committee on Health Coverage, Insurance and Financial Services.

 

“We all know prescription drugs can be outrageously expensive, and this is especially true for the most serious chronic diseases that people can face, which require extensive, ongoing maintenance medication,” said Sen. Sanborn. “Oftentimes when people are in this situation, they seek assistance paying for their medications, and some folks are fortunate to find limited financial help. This is a welcome relief, until they realize that their insurer has implemented a relatively new ‘innovation’ known as a ‘copay accumulator program.’ These ‘programs’ mean that the co-pay assistance funds they used to afford their medication won’t count toward their deductible or out-of-pocket maximum, saddling patients with additional out-of-pocket costs that offset the benefit of the copay assistance. This practice is wrong, hurts patients and provides them with no benefit. We’ve got to put an end to it.”

 

Copay accumulator programs essentially double-bill patients for their prescriptions. When a patient receives financial assistance from a drug manufacturer or third party, they are able to use those funds to help afford their prescription until the assistance lapses, but the insurance company does not count those funds toward their deductible or out-of-pocket maximum. These patients are then forced to come up with money that they weren’t planning for and that they didn’t have to begin with, which is what led them to seek financial help. If patients can find the money to continue treatment, it will likely be by making sacrifices in other parts of their life, like food or heat. If they can’t, they could be forced to stop treatment.

 

LD 1783 faces further action in committee.