Wisconsin residents would see the full value of copay assistance programs when buying prescription drugs under a bipartisan bill introduced Tuesday that would ensure all such assistance fully benefits patients, not insurance companies.
The bill, which mirrors similar legislation that failed to pass last session, would ensure that health plans count copay assistance and coupons toward the patient’s maximum out-of-pocket cost or annual deductible.
The bill, which mirrors similar legislation that failed to pass last session, would ensure that health plans count copay assistance and coupons toward the patient’s maximum out-of-pocket cost or annual deductible.
Bill co-authors Rep. Lisa Subeck, D-Madison, and Sen. André Jacque, R-De Pere, said the bill aims to close a loophole sometimes used by insurers and pharmacy benefit managers that allows them to exclude coupons and other cost-sharing assistance when calculating a patent’s out-of-pocket costs.
“If a patient uses a coupon to cover the cost of their prescription copay, it is only reasonable that they expect to be the one who benefits from the savings,” Subeck said. “Closing this loophole will provide an immediate benefit to patients by ensuring coupons and assistance programs can do what they are intended to do — help patients afford their prescription medications at the pharmacy counter.”
Jacque said the “All Copays Count” proposal aims to prevent insurers or benefit managers from “moving the goalposts.”
“For someone suffering from a complex disease, the financial hit is especially hard, leaving them to choose between groceries, utilities and mortgage payments — and the prescription medications that keep their condition under control,” Jacque said.
The average deductible for single coverage in Wisconsin was $1,364 in 2020, a more than 350% increase from 2006, and the percentage of covered workers with a general annual deductible of at least $1,000 for single coverage grew from 23% to 57% over the last five years, according to Jacque’s office.
The bill would also close a loophole that allows insurers to define certain prescription drugs as nonessential and therefore not eligible to count toward their deductible.
Wisconsin native Annette Huston, who has had multiple sclerosis for 38 years and takes medication that costs more than $152,000 a year, said her health plan does not apply the value of copay assistance to her annual deductible. She said legislation like that being proposed in Wisconsin would provide additional certainty for patients already dealing with a difficult situation.
“I am tired of 38 years of living with this scary, unpredictable, progressive, deadly disease and I’m tired of not knowing how to afford my medication,” Huston said.
More than 35 Wisconsin and national organizations, including the Wisconsin Nurses Association, Wisconsin Medical Society and Wisconsin Primary Health Care Association, have supported the proposed legislation.
More than a dozen states have already passed copay protection laws, while close to 15 more have pending legislation introduced, according to the All Copays Count Coalition.
Similar federal measures have also been introduced in Congress.
Read More At: https://madison.com/news/local/govt-and-politics/bipartisan-bill-would-ensure-copay-aid-goes-to-patients-out-of-pocket-cost-for-medications/article_7625f04d-14f8-5535-81bb-c64f940f9c0e.html
