The HIV+Hepatitis Policy Institute, a leading organization advocating for equitable and affordable healthcare for individuals living with or at risk of HIV, hepatitis, and other chronic health conditions, strongly supports Senate Bill 45. This vital legislation ensures that health insurers accept and count payments made on behalf of patients toward their deductibles and out-of-pocket maximums.
By passing Senate Bill 17, New Hampshire will join 21 other states, the District of Columbia, and Puerto Rico in protecting consumers purchasing insurance on the private market. This legislation ensures that copay assistance counts toward cost-sharing obligations, preventing patients from facing insurmountable financial barriers to their medications.
As the Oregon PDAB begins reviewing its initial list of prescription drugs, we believe that affordability reviews of HIV medications fail to fully account for the intricacies of the existing HIV safety net, which makes lifesaving HIV treatments affordable for most people. We also want to raise numerous factors in the global HIV drug ecosystem that would be difficult for a state to consider. Finally, we reiterate our support for the proposed legislative policy recommendations that enhance transparency around insurers’ use of copay accumulators, maximizers, and the need to consider alternative funding programs.
More and more insurers and PBMs have instituted harmful policies that do not apply copay assistance towards beneficiaries’ out-of-pocket costs and deductibles. Currently, 2 out of 6 health plans available on the New Jersey individual marketplace have language in their individual health plan documents stating that copay assistance may not be counted. When implementing these policies, the insurer collects the copay assistance from the drug manufacturer and the patient is able to pick up their medication, but that copay assistance is not counting towards the beneficiary’s deductible or out-of-pocket obligation. Then, later in the year, when the beneficiary goes to pick up their drug, they find out that copay assistance did not count and are stuck with a huge, unexpected copay. In order to pick up their drug they are forced to come up with often thousands of dollars, which few people have. Insurers are double dipping: first they receive the copay assistance from the drug manufacturer and then they collect it again from the beneficiary.
We strongly support Utah’s “Health Insurance Modifications,” which would require health insurers to accept and count payments made on behalf of patients towards deductibles and out-of-pocket maximums. We thank you for introducing this bill and look forward to its passage by the Judiciary Interim Committee.