copay accumulator Archives - HIV+Hepatitis Policy Institute

Concerns with Rhode Island Drug Cost Review Commission (H 8220)

May 8, 2024

We believe policymakers should focus on those issues that directly impact patients, such as PBM regulation and reform, standard plan designs with reasonable deductibles and nominal copays, and ensuring copay assistance counts. For example, Rhode Island still allows issuers to implement harmful copay accumulator adjustment policies that permit double-dipping by payers to take copay assistance without crediting beneficiary out-of-pocket costs.

Support letter to CA State Assembly Appropriations Committee for AB 2180 on cost-sharing

May 6, 2024

HIV+Hep strongly supports AB 2180. It simply requires that the copay assistance which beneficiaries receive counts towards their out-of-pocket obligations. By passing this law, California will join 20 other states (Arkansas, Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, New Mexico, New York, North Carolina, Oklahoma, Oregon, Tennessee, Texas, Washington, West Virginia, and Virginia), Puerto Rico and the District of Columbia in protecting consumers by assuring their copay assistance will count towards cost-sharing obligations.

Comments on ERISA’s 50th anniversary–reforms to increase affordability and quality in employer-sponsored health coverage

Mar 15, 2024

Employer-sponsored insurance is the most common form of health insurance in the United States, covering over 60 percent of the population under 65.[1] As we detail below, many employers have begun to create new health insurance barriers that prevent employees and their family members from accessing the medications they need to stay alive and healthy. Our comments focus on certain novel benefit designs that have become more prevalent in recent years among employer-sponsored insurance plans: copay accumulators, copay maximizers, and alternative funding programs, as well as the practice of skirting ACA requirements by designating certain specialty medications as non-Essential Health Benefits.

Request for prompt enforcement of prescription drug copay assistance court ruling

Mar 12, 2024

We have long advocated for affordable access to healthcare, including prescription medications. A recent United States District Court for the District of Columbia ruling pertaining to copay assistance will dramatically help patients afford their medications. We write to urge you to immediately enforce this decision and the rule that it reinstated, issue a bulletin advising insurers that they are obligated to comply with the reinstated rule, and take necessary enforcement actions against insurers that are not in compliance.

Letter in support of Missouri SB 844

Jan 23, 2024

It is a pleasure to voice our strong support for Senate Bill 844 (“Requires any amount paid on behalf of a health benefit plan enrollee to count toward the enrollee’s cost-sharing”) which provides that when calculating an enrollee’s overall contribution to an out-of-pocket max or any cost-sharing requirement under a health benefit plan, a health carrier or pharmacy benefits manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee for any medication for which a generic substitute is not available. We thank you for holding a hearing on this important issue and ask that you consider and pass the bill.

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