Two lawmakers pitched a bill Tuesday they say would block insurers from a practice that shifts health care costs onto patients with chronic diseases who require expensive drugs.
Speaking to the House Health Committee, Reps. Susan Manchester, R-Waynesfield, and Thomas West, D-Canton, proposed prohibiting insurers from using “copay accumulator” policies.
These policies prohibit patients from using money from third parties, like charities or manufacturer coupons, to use toward their deductible and out-of-pocket limit on their health insurance plans.
The prohibition, however, would only apply when there’s no “medically appropriate generic equivalent” of the drug available.
Last week, the Capital Journal reported how these policies effectively cost thousands for people with complex diseases like HIV, hemophilia, and multiple sclerosis.
While an array of patient groups and the pharmaceutical industry support the legislation, insurers oppose it, alleging manufacturers inflate the list price of drugs and offer patients the assistance to bilk more money from insurance companies.
West Virginia, Virginia, Arizona and Illinois have banned the practice, which has grown in recent years among insurers.
West told the committee the legislation is a piece of the answer to helping people cover their drug costs, instead of leaving them to resort to dangerous measures like skipping doses or rationing medication.
During the hearing, Chairman Scott Lipps, R-Franklin, asked West what happens when people can’t pay for their medications at the pharmacy counter.
“If they can’t pay their deductible, they don’t get their medication,” West replied.
Manchester referred to the practice as a form of “surprise medical billing,” and emphasized the long list of patient groups backing the bill.