Lesic & Camper Communications
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Ohio House Bill 469

ALL COPAYS COUNT

(COLUMBUS) -- Ohio House Bill 469 was introduced by joint-sponsors Rep. Susan Manchester (R- Waynesfield) and Rep. Thomas West (D-Canton) to address the discriminatory health plan policies known as copay accumulator adjustors. These policies drive up out-of-pocket costs for patients’ prescription medications, often as a surprise to both patients and providers. 


When it comes to prescription medication coverage, health plans and pharmacy benefit managers (PBMs) continue to shift the cost burden to patients through high deductible or co-insurance and multi-tiered formularies with specialty drugs in the highest cost-sharing category.


Many drug manufacturers, as well as health foundations and charities, help patients with assistance programs, which could include funding, as well as copay cards or coupons for use to cover out-of-pocket costs. These programs are critical for patients with chronic, complex conditions. 


Insurers and PBMs are refusing to count copay assistance payments toward the patients’ deductibles. Patients are required to pay an increasing amount of out-of-pocket money at the beginning of their plan year before the plan provides coverage. By not counting the assistance toward a patient’s cost-sharing, plans target those who need help. Even more disturbing is that accumulator adjustment programs double-dip. The plans keep the assistance payment in addition to any copays paid directly by the patient while in the deductible phase.


Ohioans need health insurers and PBMs to count all payments and not discriminate against those patients living with a chronic condition or battling a life-threatening illness. When the patients’ share of prescription costs becomes too high, many may skip doses or stop taking medication entirely, leading to higher medical costs down the road, in terms of hospitalizations, ER visits, and long-term health issues. 


Lesic & Camper is helping to build a coalition of patient advocacy groups and health care providers to work with the Ohio legislature to address discriminatory and unpredictable health plan practices that drive up out-of-pocket costs for patients’ prescription medications. 

Stakeholder Groups

AIMED Alliance

Alliance for Patient Access

American Autoimmune Related Diseases Association

American Cancer Society Cancer Action Network

American Diabetes Association

Arthritis Foundation

Association of Women in Rheumatology

BioOhio

Cancer Support Community Central Ohio

Chronic Disease Coalition

Coalition of State Rheumatology Organizations

Crohns & Colitis Foundation

Epilepsy Foundation

Equitas Health

Global Healthy Living Foundation

HIV + HEP Policy Institute 

Immune Deficiency Foundation

Little Hercules Foundation

Mental Health & Addiction Advocacy Coalition

Mental Health America Franklin County

National Infusion Center Association

National Multiple Sclerosis Society

National Organization for Rare Disorders

National Organization of Rheumatology Managers

National Psoriasis Foundation

Ohio Academy of Nutrition and Dietetics

Ohio Association of Rheumatology

Ohio Bleeding Disorders Council

Ohio Chapter, American Academy of Pediatrics

Ohio Chapter of the American College of Cardiology

Ohio Chapter of the National Association of Pediatric Nurse Practitioners

Ohio Dermatological Association

Ohio Foot and Ankle Medical Association

Ohio Hematology Oncology Society

Ohio Osteopathic Association

Ohio Pharmacists Association

Ohio Psychiatric Physicians Association

Ohio Psychological Association

Ohio Sickle Cell and Health Association

Ohio State Grange

Ohio State Medical Association

Pharmacists United in Truth & Transparency

The AIDS Institute 

The Academy of Medicine of Cleveland and Northern Ohio