(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.
Alliance for Patient Access
American Autoimmune Related Diseases Association
American Cancer Society Cancer Action Network
American Diabetes Association
Association of Women in Rheumatology
Cancer Support Community Central Ohio
Chronic Disease Coalition
Coalition of State Rheumatology Organizations
Crohns & Colitis Foundation
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