WASHINGTON, D.C. – Reps. Earl L. “Buddy” Carter (R-GA), Nanette Barragán (D-CA), Miller-Meeks (R-IA), and Diana DeGette (D-CO) this week introduced the Help Ensure Lower Patient (HELP) Copays Act to protect patients from harmful insurance and pharmacy benefit manager practices that raise patient out-of-pocket drug costs.
The bipartisan HELP Copays Act would prohibit the use of “copay accumulator” schemes that health plans and pharmacy benefit managers (PBMs) developed to pocket a patient’s copay assistance by excluding the cost-sharing assistance from counting towards a patients’ deductible or out-of-pocket maximum. After the copay assistance card runs out, the patients can be hit with surprise four-figure refill bills until the deductible or max is met. This bill would require health plans and PBMs to count the value of copay assistance towards a patient’s cost-sharing requirements, preserving the original intent of the copay assistance program.
“Only health plans and PBMs could take a program designed to reduce patients’ out-of-pocket prescription drug costs and turn it into a money-making machine,” said Rep. Carter. “Especially now, with inflation near forty-year highs, Congress must use all tools at its disposal to help Americans stretch the value of their dollar. I’m glad to introduce this bipartisan bill alongside Congresswoman Barragán and several other colleagues who share our commitment to make health care more affordable.”
“Patients shouldn’t face complicated financial barriers to access lifesaving prescription drugs,” said Rep. Barragán. “So many families depend on copay assistance programs to offset soaring drug prices. High costs of prescription drugs disproportionately impact Latinos, with 1 in 3 Latinos being unable to fill their prescriptions because of cost. We must do what we can to lower their out-of-pocket costs.
“Health plans and PBMs should not be in the business of forcing families to make a choice between their medicine and their expenses. That’s why I am proud to introduce this bipartisan legislation to protect patients who rely on copay assistance and ensure that prescriptions remain accessible for many families across L.A. County.”
“Lowering drug costs has remained one of my top priorities throughout my time in Congress,” said Representative Miller-Meeks. “Copays are designed to make drug costs manageable—there is no reason third party PBMs should be profiting from this deposit. Our bill will protect patients and ensure their copays are going toward the cost of their medications.”
“We must do more to lower the cost of health care in this country,” DeGette said. “This legislation will provide real relief for those struggling to afford the cost of their medication. Not only will it make prescription drugs more affordable for many Americans, it will also help lower the total out-of-pocket health care costs that millions of hardworking Americans are forced to pay each year.”
The bill is co-sponsored by Reps. Brian Fitzpatrick (R-PA), Bonnie Watson Coleman (D-NJ), and Yvette Clarke (D-NY) and mirrors policy that 16 states and Puerto Rico have already enacted to ensure copay assistance counts towards patients’ out-of-pocket costs.
“For too long, health plans and PBMs have had the power to reap greater profits at the expense of patients through the use of policies that don’t count the value of copay assistance. The HELP Copays Act will right that wrong by ensuring that copay assistance counts for patients, so they can afford the care and treatment they need. We applaud Representatives Carter, Barragán, Clarke, Coleman, DeGette, Fitzpatrick, and Miller-Meeks taking on this important issue on behalf of people living with chronic illness," said Rachel Klein, Deputy Executive Director, The AIDS Institute.
“CSC’s online survey that captures the voices of patients, caregivers, and survivors, shows that 1 in 3 cancer patients who participated reported being moderately to severely worried about finances and health insurance. No one who needs prescription drugs for lifesaving treatment or medical management should face financial ruin as a result, especially when they are participating in programs designed to alleviate that burden. We thank Representatives Carter, Barragán, Clarke, Coleman, DeGette, Fitzpatrick, and Miller-Meeks for their leadership in introducing the HELP Copays Act," said Debbie Weir, CEO, Cancer Support Community.
“The HELP Copays Act would be life-changing for countless people with arthritis who rely on co-pay assistance to afford their increasingly unaffordable out-of-pocket medication costs, only to be told this assistance isn’t counting towards their cost-sharing. We’ve heard too many heartbreaking stories in recent years of patients in accumulator adjustment programs having to stop effective treatments that are working for them because they can no longer afford it after their assistance runs out. A patient’s health should not worsen because of an insurance barrier. We applaud Representatives Buddy Carter and Nanette Barragán for leading the way in ensuring no patient is forced to make the trade-off between affording their medications and their health," said Steve Taylor, CEO, Arthritis Foundation.
"The National Hemophilia Foundation (NHF) is grateful for the bipartisan support, led by Representatives Carter and Barragán and their colleagues, that has led to the introduction of the HELP Copays Act. This critical effort will eliminate barriers to treatment for some of this country’s 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. NHF is grateful for the work of the late Rep. Donald McEachin – without his attention and dedication, today’s introduction would not have been possible," said Dr. Leonard A. Valentino, President & CEO, National Hemophilia Foundation.
“Seventy percent of people with multiple sclerosis have relied on financial assistance to support the out-of-pocket costs associated with the medications they need. Copay accumulator programs create real barriers that prevent people with MS and other health conditions from getting the medicines they need," said Bari Talente, EVP of Advocacy and Healthcare Access, National Multiple Sclerosis Society.
Read the full bill text here.
Read Rep. Carter’s report on predatory PBM practices here.
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