Health care costs are already expensive, so why are insurance companies allowed to charge double the amount for the same lifesaving medication?
Unfortunately, insurers have been allowed to manipulate copay accumulator policies, forcing patients to pay more. That’s because copay assistance – which is often offered by third parties and manufacturers to lessen the cost of medication for the patient – isn’t counted toward their annual deductible. This broken system often requires patients to pay expenses out of their own pocket, even though the insurer has already received payment from another source.
Put simply, insurance companies have maneuvered their way to double-dip and it’s the most vulnerable patients who are impacted.
Fortunately, state lawmakers are considering legislation–SB 1480 and HB 1063–that would put a stop to these predatory practices by banning so-called “copay accumulator policies” in insurance coverage. It’s the best way to make sure hundreds of thousands of vulnerable Floridians can continue to receive the life-sustaining medications they so desperately need.
To help pay out-of-pocket costs for specialty medicines, Floridians with serious, complex, chronic health conditions rely on copay assistance from manufacturers or charitable foundations. These individuals are coping with conditions that include cancer, multiple sclerosis, epilepsy, hepatitis C, and HIV – the disease state I’m most familiar with through my work as a nurse over the last 30 years. These patients require an uninterrupted medication regimen to avoid disease progression, hospitalization, or even death.
Unfortunately, many patients struggle to afford the monthly copays and cost-share amounts their insurance companies impose.
These practices target the most vulnerable patients and exacerbate existing health disparities. As a result, hundreds of thousands of Floridians – even those with good insurance – face the reality of not being able to afford the life-sustaining medications they so desperately need.
The average insurance deductible for an ACA plan in Florida is over $5,000, and cost-sharing for some prescription drugs can be thousands of dollars per month. IQVIA, a health information technology firm, recently found that 40 percent of patients choose not to fill their prescriptions when faced with out-of-pocket costs of just $75 to $125 – and a stunning 70 percent leave the pharmacy without their medication when it hits $250.
It really shouldn’t matter to the insurance company where the money comes from to enable patients to meet their copay or out-of-pocket costs. All money that helps purchase a patient’s prescriptions – whether it’s from a manufacturer’s copay assistance, a nonprofit foundation, or even the patient’s family – should be counted toward meeting the deductible and out-of-pocket costs. Copay accumulator policies shift more costs to patients who have serious, complex, chronic illnesses, making it harder for them to afford the medicines they need.
It’s time for Florida to join the growing number of states that have put patients first. I urge legislators listen to the stories of patients who experience these hardships every day and support SB 1480 and HB 1063. It’s well overdue and time to end these unfair and dangerous copay accumulator policies.
Donna Sabatino serves as the Director of State Policy and Advocacy for the AIDS Institute. She is also a nurse who has more than 30 years of clinical experience working with HIV patients. Sabatino lives in Flagler Beach.
