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CCPA Supports Legislation Sponsored by the All Copays Count Coalition

CCPA is actively involved in providing support and leadership at the State and Federal levels of the All Copays Count Coalition and is proud to support the goal of passing the HELP Copays Act (H.R. 830). The All Copays Count Coalition works to ensure that all copayments made by or on behalf of a patient count toward their deductible and out-of-pocket limit, and that patients can access the medications they need. Read the press release below, published by the coalition:

National Coalition Applauds Bipartisan Federal Legislation to Ensure Copay Assistance Counts for Patients

HELP Copays Act Would Protect Treatment Affordability for Vulnerable Patients

WASHINGTON, DC – February 9, 2023 – Today, 75 national patient and provider advocacy groups that make up the All Copays Count Coalition applauded the reintroduction of the Help Ensure Lower Patient (HELP) Copays Act, bipartisan federal legislation to ensure vulnerable patients can access and afford the necessary and life-saving medications prescribed by their doctors. The HELP Copays Act (H.R. 830) would require insurers and pharmacy benefit managers (PBMs) to count the value of copay assistance for covered prescription drugs toward patient cost-sharing requirements in individual, small group, and employer-sponsored health plans. H.R. 830 is championed by a bipartisan group of members of the House of Representatives, including Representatives Earl “Buddy” Carter (R-GA), Nanette Diaz Barragán (D-CA), Brian Fitzpatrick (R-PA), Diana DeGette (D-CO), Mariannette Miller-Meeks (R-IA), Bonnie Watson Coleman (D-NJ), and Yvette Clarke (D-NY).

“The HELP Copays Act represents a bipartisan, commonsense solution to improve patient access to their prescription medications and rein in notoriously opaque policies and practices that plans and PBMs use to pad their bottom lines,” said Rachel Klein, Deputy Executive Director at The AIDS Institute, a steering committee member of the All Copays Count Coalition. “Our Coalition stands ready and eager to work with these patient champions to advance this legislation that will make a meaningful difference to help patients afford the medications they need.”

Too frequently, health plans and PBMs have instituted copay accumulator adjustment policies that don’t count the value of copay assistance from drug manufacturers and non-profits towards a patient’s out-of-pocket maximum or annual deductible. Copay accumulator policies enable plans and PBMs to “double dip” to increase profits and often leave patients with a “copay surprise” at the pharmacy counter when their assistance has run out and they are still responsible for the full amount of their deductible. According to a 2023 report from The AIDS Institute, at least two-thirds (64%) of health plans in the country include a copay accumulator adjustment policy. In 24 states, over half of all plans include a copay accumulator adjustment policy. A new video from the AIDS Institute explains more about how copay accumulators harm patient access.

“IDF has been vocal about the harm copay accumulators pose to patient access to critical medications and has galvanized support for state-level bans across the country, said Lynn Albizo, Vice President of Public Policy at the Immune Deficiency Foundation. “We are pleased to see the HELP Copays Act introduced to fight the same health insurance practice at the federal level. IDF strongly believes that #AllCopaysCount and patients should not be penalized for using assistance programs to afford their medications.”

The HELP Copays Act eliminates barriers to care by:

  • Requiring health plans to count the value of copay assistance toward patient cost–sharing requirements; and
  • Ending an insurer/PBM practice classifying certain medications as “non–essential” to avoid out–of–pocket maximums

There is growing support for federal policy efforts to ensure copay assistance counts toward patient costs.

  • States Are Taking Similar Action to Ensure Copay Assistance Counts. To date, 16 states and Puerto Rico have already enacted policy to ensure copay assistance counts towards patients’ out-of-pocket costs.
  • Copay Assistance Reduces Costs and Improve Health Outcomes. From 2015-2020, Out-of-pocket (OOP) costs in the commercial market declined by 6.3% due to the use of copay assistance leading to $12 billion in OOP savings for patients. Copay assistance increases drug utilization which leads to 1.0 to 3.3% better health outcomes.
  • Americans Believe the Government Should Ensure Copay Assistance Counts. According to a National Hemophilia Foundation survey, more than 80 percent of voters political parties believe the government should require copay assistance to be applied to patients’ out-of-pocket costs.

You can read more about Co-pay Accumulator programs here in our blog series titled Copay Accumulator Series Part 1 and 2.