COLUMBUS – State Representatives Susan Manchester (R-Waynesfield) and Thomas West (D-Canton) recently introduced House Bill 135, which would cut out-of-pocket prescription drug costs for patients. The legislation is supported by a large coalition of patient advocate and healthcare provider organizations.
Some patients with chronic, complex conditions such as multiple sclerosis and hemophilia rely on copay assistance programs offered through drug manufacturers, charities, and other third-party organizations to help cover the costs of their prescription drugs. Health insurance providers and pharmacy benefit managers (PBMs) have increased their use of discriminatory policies that disallow payments made through copay assistance programs to count toward a patient’s deductible.
These discriminatory practices are referred to as copay accumulator adjustment policies. Patients impacted by these copay accumulator policies are often unaware they exist and are blindsided once they learn these payments did not apply to their deductible. With accumulators, health plans double their take, by pocketing the assistance payment and never allowing it to contribute to the deductible, and then still requiring the full deductible payment to be made by the patient.
House Bill 135 directs health insurers and PBMs to apply all payments made by either the patient or on the patient’s behalf through an assistance program, to count toward a patient’s deductible.
“Copay accumulator policies discriminate against patients with chronic conditions, as well as those who need innovative prescription drugs for which no generics typically exist,” said Manchester. “House Bill 135 fights to cut out-of-pocket prescription drug costs for our families.”
House Bill 135 would not interfere with health insurance plans or PBMs policies to save money by requiring the use of generic medications. The language specifically states, “…this requirement shall not apply with respect to cost-sharing for a drug for which there is a medically generic equivalent.”
House Bill 135 will help Ohioans who are reeling from the pandemic and will have a lasting effect on patients with rare diseases, saving them thousands of dollars on prescription costs.
“Insurers and PBMs continue their false narratives about patient assistance programs. In the midst of a pandemic, this continued attack on our patients must stop,” said West. “Similar legislation has passed in five states and Puerto Rico and could be introduced in more than 20 states this year. It’s time we protect Ohio patients, so they have the opportunity to thrive, not just survive.”