A coalition of patients, patient advocacy organizations and health care providers today urge Pennsylvania lawmakers to support House Bill 2226/SB268, legislation that when passed into law will ensure that patients are getting the full benefit of third party co-pay assistance programs to pay for medications that treat a variety of serious health conditions and improve patients’ survival and quality of life.
Currently, a majority of private insurers (80%) have put in place barriers to these life-saving medications, through what’s known as ‘copay accumulator adjustor programs,’ or CAAPs. These programs prevent the copay assistance that patients receive from counting towards their deductibles and out-of-pocket costs. Instead, even though financial assistance is paid on behalf of the patient, when the copay assistance runs out, the patient is still charged the full amount of the deductible. Patients are forced to make impossible choices because of this, choosing between different forms of care and meeting their families’ basic needs.
Introduced in the Senate by Senator Judy Ward (R-District 30) along with Senator Maria Collett (D-District 12), who serve as the Senate Co-Chairs of the Rare Disease Caucus, the lawmakers note in their legislative memo the impact that prescription drug copay accumulator adjustment programs have on the rare disease community: “Unexpected costs imposed by co-pay accumulators can cause patients to delay treatment or forgo medication.”
The House companion bill, introduced by Representative Emily Kinkead (D-House District 20) along with Reps. Kuzma (R-House District 39), Khan (D-House District 194), Hanbridge (D-House District 61) and Parker (D-House District 198) says their legislation is “important, common-sense step that delivers immediate relief at a time when costs are rising across the board.”
Patients agree. Jamie Wright is a cancer survivor from Allegheny County who relies on assistance to pay for the $1,400 monthly copay for his shot to treat his very rare neuroendocrine cancer. None of the assistance he and his wife Carrie receive goes toward their $15,000 out-of-pocket maximum.
“We’re at a point now, given the ever-rising costs associated with my cancer, where I am considering skipping critical scans so that we can minimize our costs. And that’s even with the assistance I receive. Copay accumulator adjustment programs undermine the support patients are promised and leave us without the relief we desperately need,” said Jamie. “We owe it to patients to end this unfair practice and make all copays count.”
This is a non-partisan issue, evidenced by 26 states, Washington D.C. and Puerto Rico, including Commonwealth neighbors New Jersey and New York, having passed copay accumulator reforms to date.
“We are thrilled that legislation to eliminate the copay accumulator loophole has been filed in both chambers with bipartisan support,” said Donna Greco, who serves as the government relations director for the American Cancer Society Cancer Action Network in Pennsylvania and coalition lead. “We are hopeful that Pennsylvania will join the other states who have prioritized lowering out-of-pocket costs for people with cancer and other serious illnesses as they face increasing health care costs in their fight to survive.”
The coalition urges the House and Senate Insurance Committees to make all copays count and pass HB 2226/SB 268 this session.
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About ACS CAN
The American Cancer Society Cancer Action Network (ACS CAN) advocates for evidence-based public policies to reduce the cancer burden for everyone. We engage our volunteers across the country to make their voices heard by policymakers at every level of government. We believe everyone should have a fair and just opportunity to prevent, detect, treat, and survive cancer. Since 2001, as the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN has successfully advocated for billions of dollars in cancer research funding, expanded access to quality affordable health care, and advanced proven tobacco control measures. We stand with our volunteers, working to make cancer a top priority for policymakers in cities, states and our nation’s capital. Join the fight by visiting www.fightcancer.org.