Ohio’s lawmakers can help patients afford critical treatments by ensuring all payments — made by or on-behalf of patients — are counted toward the patients’ deductibles and out-of-pocket maximums.
It’s time for lawmakers to protect Ohio patients by voting YES for House Bill (HB) 135!
The Problem: Copay Accumulator Adjustment Programs
Copay Assistance is financial assistance typically provided by charitable organizations or drug manufacturers to help patients pay out-of-pocket costs for their medications or health care services. Although sometimes called “copay coupons” or “copay cards” it is important to remember that copay assistance is real money.
Health insurers and pharmacy benefit managers use a wide variety of hidden policies, known as copay accumulators, to block copay assistance toward a patient’s deductible or out-of-pocket maximum for their medications. Copay accumulators allow insurance companies to shirk their fiduciary responsibilities by excluding copay assistance from a patient’s cost sharing.
- They increase out-of-pocket costs: When copay assistance runs out, patients are stuck paying the bill, a second time, out of their own pocket.
- May lead to worse health outcomes: Patients are far more likely to abandon their treatment when out-of-pocket costs exceed $100.
- Nonadherence: Health care spending on emergency visits, hospital stays, and avoidable procedures increases when patients cannot afford treatments to manage their chronic disease.
- Allows insurers and Pharmacy Benefit Managers (PBMs) to shirk their fiduciary responsibility: Insurers and PBMs “double dip” because out-of-pocket costs are paid twice — first from copay assistance and then from patients — helping themselves, not Ohio patients!
Solution: Ensure All Copays Count by passing Ohio HB 135
Ohio’s lawmakers can help patients afford critical treatments by ensuring all payments — made by or on-behalf of patients — are counted toward the patients’ deductibles and out-of-pocket maximums.