Support for NJ S3818/A5217 to ban copay accumulators
Senate Budget and Appropriations Committee
125 W State Street
Trenton, NJ 08608
Dear Chair Sarlo and Members of the Senate Budget and Appropriations Committee:
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 strongly support Senate Bill 3818/Assembly Bill 5217 which ensures that health insurers accept and count payments made on behalf of patients toward their deductibles and out-of-pocket maximums.
The Harmful Impact of Copay Accumulators
Copay accumulators are harmful policies increasingly implemented by insurers, employers, and pharmacy benefit managers (PBMs). Under these policies, copay assistance provided by drug manufacturers does not count toward patients’ cost-sharing obligations, such as deductibles and out-of-pocket maximums. While patients can initially use the assistance to afford their medications, they often face unexpected and substantial costs later in the year when the assistance runs out, leaving them unable to pay for their prescriptions.
When copay assistance is not counted toward patients’ cost-sharing obligations patients are left in a precarious situation: insurers collect the manufacturer’s copay assistance, but the patient receives no credit toward their deductible or out-of-pocket maximum. Later, when patients return to refill their medications, they are often hit with unaffordable copays effectively forcing them to pay twice. This “double-dipping” practice unfairly burdens patients and jeopardizes their ability to adhere to life-sustaining treatments.
Why Senate Bill 3818/Assembly Bill 5217 Is Essential
By passing S3818/A5217, New Jersey will join 25 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.
For people with HIV, hepatitis, and other chronic conditions, reliable access to medication is critical. Individuals with HIV and hepatitis B require lifelong drug regimens, while those with hepatitis C can be cured in as little as 8 to 12 weeks. Yet high deductibles and cost-sharing requirements often make these treatments unaffordable, even for insured patients. Copay assistance is a lifeline, particularly in today’s challenging economic climate, where inflation and rising costs are straining household budgets.
When patients are forced to forego their medications due to high costs, the consequences are severe, not just for individual health outcomes, but also for public health and healthcare system costs. Policies that limit access to copay assistance exacerbate these challenges, disproportionately affecting those who are already vulnerable. Senate Bill 3818/Assembly Bill 5217 represents an essential safeguard against harmful insurer practices, ensuring equitable access to life-saving treatments for New Jerseyans.
If you have any questions or need additional information, please feel free to contact our Government Affairs Manager, Zach Lynkiewicz, at zlynkiewicz@hivhep.org.
Thank you for your consideration and leadership on this critical issue.
Sincerely,
Carl E. Schmid II
Executive Director
cc: Senate Budget and Appropriations Committee
Senate President Nicholas P. Scutari
Senator Jon M. Bramnick