Letter to Louisiana Senate Health Committee Opposing Copay Maximizers
Senate Committee on Insurance
Louisiana State Senate
900 North Third Street
Baton Rouge, LA 70802
Dear Chair Talbot and Members of the Senate Committee on Insurance,
The HIV+Hepatitis Policy Institute is a national organization promoting quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions. While we share your commitment to addressing the high cost of prescription drugs, we strongly oppose HB 1236, legislation that would explicitly authorize the use of copay maximizer programs in Louisiana’s health insurance market.
Copay Maximizers Endanger Patient Copay Assistance
Copay maximizer programs, like their counterpart copay accumulators, are insurer and pharmacy benefit manager (PBM) benefit designs that prevent manufacturer copay assistance from counting toward a patient’s deductible or annual out-of-pocket maximum. These programs often designate certain medications as “non-Essential Health Benefits” to bypass Affordable Care Act cost-sharing protections, allowing plans to impose cost-sharing levels that would otherwise not be permitted and capture the full value of copay assistance rather than applying it to reduce patients’ costs.
While some maximizer programs are described as “voluntary” or “optional,” they are structured in a way that effectively coerces participation. Patients who do not enroll may face significantly higher coinsurance, sometimes as high as 30 percent, for the same medications.
The growing use of maximizers threatens the long-term viability of copay assistance programs, which saved patients an estimated $23 billion in prescription drug costs in 2024 alone.[1] Without this critical support, many patients would face unaffordable costs for life-saving medications.
These Programs Conflict with Federal Protections
HB 1236 would put Louisiana law in direct conflict with federal law for the individual and small group markets. In the final 2025 Notice of Benefit and Payment Parameters (NBPP), the Centers for Medicare & Medicaid Services (CMS) clarified the long-held policy that any prescription drug covered by a plan must be treated as an Essential Health Benefits (EHB), closing the loophole exploited by copay maximizers.
HB 1236 Is a Step Backward for Patients
Louisiana has already enacted strong protections to shield patients from harmful insurance benefit designs. In 2021, the state required that all payments made on behalf of a patient count toward their cost-sharing obligations, ensuring that manufacturer assistance directly benefits patients and effectively prohibiting the use of copay accumulator and maximizer programs.[2]
By explicitly authorizing maximizer programs, this legislation would reverse Louisiana’s prior progress and create a loophole that allows plans and their pharmacy benefit managers to capture copay assistance rather than allowing it to reduce patients’ out-of-pocket costs. At a time when patients rely on this assistance to afford essential medications, Louisiana should be reinforcing its existing protections, not weakening them.
Access to Life-Saving Treatment Is at Risk
Copay assistance programs exist to help patients afford the high costs of essential medications. For people living with HIV and hepatitis B, lifelong daily treatment is required. For hepatitis C, a curative treatment is available but often comes with a high upfront cost. Without assistance that counts toward out-of-pocket limits, patients in high-deductible or high-cost-sharing plans may be forced to go without treatment. Allowing maximizer programs to flourish, particularly under the false premise that they benefit patients, only reinforces barriers to treatment.
We urge you to reject HB 1236.
If you have any questions or need any additional information, please do not hesitate to reach out to our Government Affairs Manager, Zach Lynkiewicz, at zlynkiewicz@hivhep.org.
Sincerely,
Carl E. Schmid II
Executive Director
[1] IQVIA Institute for Human Data Science, The Use of Medicines in the United States 2024.
[2] LA Rev Stat § 22:976.1 (2025)