Cost-sharing

Support for Rhode Island’s H 8041 “An Act Relating to Insurance—Prescription Drug Benefits”

Apr 4, 2024

We voice our strong support for Rhode Island’s H 8041 (“An Act Relating to Insurance—Prescription Drug Benefits”) which stipulates that, when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health plan, an insurer or pharmacy benefit manager shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person. We thank you for considering this legislation and are pleased to offer our support.

Support for CA AB 2180 “Health Care Coverage: Cost Sharing”

Mar 25, 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 19 other states (Arkansas, Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, Oklahoma, North Carolina, New Mexico, New York, 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.

Testimony on the selection of drugs for referral to MD stakeholder council

Mar 20, 2024

We believe Maryland 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. We note that the General Assembly is currently considering HB 879, legislation that would ensure that copay assistance programs will count toward deductibles and out-of-pocket maximums, and the Senate is considering SB 595.

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.

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