Letter to Louisiana Senate in Opposition to Reinstating Copay Maximizer Language in HB 1236
Louisiana State Senate
900 North Third Street
Baton Rouge, LA 70802
Dear President Cameron Henry and Members of the Louisiana Senate,
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. We appreciate the Senate Committee on Insurance’s decision to remove the copay maximizer provisions from HB 1236 and we strongly oppose efforts to reinstate those provisions through a floor amendment.
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.[i] Without this critical support, many patients would face unaffordable costs for life-saving medications.
These Programs Conflict with Federal Protections
Reinstating the copay maximizer provision into 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.
Reinstating Copay Maximizers Would Be 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.[ii]
Adding copay maximizer language back into the bill 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 oppose any amendment that would reinstate copay maximizer language into 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
cc: Frank Opelka, Deputy Commissioner of Insurance
[i] IQVIA Institute for Human Data Science, The Use of Medicines in the United States 2024.
[ii] LA Rev Stat § 22:976.1 (2025)