Prescription drugs sit on a pharmacist’s counter. Photo by John Moore/Getty Images.
The Ohio House unanimously passed legislation Wednesday that blocks health insurers from a comparatively stingier accounting practice that requires patients to pay more out of pocket to meet their deductible.
To buy expensive drugs, some patients use third parties like charities or manufacturer coupons until they hit their deductibles, at which point insurers pick up the cost of care. In response, insurers adopted policies known as “co-pay accumulators” that discount third-party payments toward patients’ deductibles. The policies have hit unsuspecting patients with huge bills at the drug counter.
House Bill 135 — sponsored by Reps. Susan Manchester, R-Waynesfield, and Thomas West, D-Canton — prohibits this insurance practice. The two introduced the same bill during the previous legislative session that stalled out.
Manchester said the legislation is aimed to help Ohioans with complex, chronic conditions, especially those who need name brand drugs with no generic equivalent. West made similar comments, citing some of the patient groups like the AIDS Institute who support the legislation.
“The sun is shining on the Ohio General Assembly today,” West said in a floor speech. “The sun is shining on the American Cancer Society.”
As of fall of 2021, 12 states and Puerto Rico have passed similar legislation, according to the National Conference of State Legislatures. Its supporters in committee include an array of patient groups, physicians associations, and pharmacists.
“Patients living with complex and/or chronic conditions are finding it increasingly difficult to manage their health due to the high co-pays implemented by their insurers,” said Monica Hueckel, a lobbyist with the Ohio State Medical Association.
“Our members see firsthand how policies like copay accumulator programs subject patients to yet another barrier in access to care, and create more obstacles in the path toward proper maintenance of medical conditions and improvement of a patient’s quality of life.”
Health insurers oppose the idea, arguing drug coupons are used by manufacturers to “circumvent” patient cost sharing, which will lead to higher insurance premiums. Kelly O’Reilly, president of the Ohio Association of Health Plans, argued manufacturer coupons steer patients toward more expensive drugs when cheaper ones are available.
Ohio House Majority Leader Bill Seitz, R-Greene Twp., pumped the brakes on the legislation, according to the Columbus Dispatch. An influential member of the caucus, Seitz requested amendments that generally affirm that the bill won’t force insurers to cover costs of drugs outside their formularies. The House-passed version heeded the changes.
The legislation still allows insurers to use accumulator policies on brand name drugs if a generic equivalent exists, unless the prescriber determines the brand name version is medically necessary.
“I think this was a bill to help patients, and those who have medical issues, be able to better afford them,” said House Speaker Bob Cupp, R-Lima.
After the vote, Holly Pendell of the National Multiple Sclerosis Society, issued a statement applauding the House passage vote.
“For years, Ohioans who rely on medications for the treatment of their chronic conditions have faced ‘copay accumulator’ policies by health insurers, which prevent them from reaching their deductibles and co-pay requirements,” she said. “These policies have resulted in higher cost burdens and barriers to medication access for many Ohioans relying on medications for the treatment of their chronic conditions.”
The legislation now moves to the Senate for consideration.
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