Ending copay accumulator programs would make prescription drugs more affordable

By Jenna McGuinness

There’s nothing more important than one’s health and the health of loved ones. All families have experienced a serious illness at one point or another — and many must deal with complex chronic illnesses. As someone who lives with a bleeding disorder, an autoimmune disorder, a child with a chronic respiratory condition, and a partner with a chronic autoimmune disease, I understand these challenges firsthand. I am far from alone. More than half of adults in our country live with a diagnosed chronic disease, and in Ohio, rates are even higher.

Thankfully, over the last two decades, advancements in modern medicine to treat chronic illnesses like mine, as well as other complex diseases like diabetes, cancer, cystic fibrosis, and lupus, have allowed those of us afflicted to live longer and fuller lives.

However, these new therapies and medications are only effective if they are accessible. For far too many people, cost serves as a devastating barrier to access. Between my medication and the medication needed to keep my daughter’s chronic illness under control, our monthly prescription bills are a challenge. Some have it even worse. Nearly a third of American adults don’t take their prescription because they can’t afford it, and upwards of 35 million have a friend or family member who died after being unable to pay for medical treatment.

Despite some strides toward lowering the cost of drugs, overall costs have increased significantly and Americans continue to pay more for prescription drugs than residents of any other country. In an effort to ensure patients could afford their medications, drug manufacturers and nonprofits created co-pay assistance programs.

But insurance companies and Pharmacy Benefit Managers (PBMs) – the middlemen that manage prescription drug benefits of health insurers – felt the assistance encouraged patients to use more expensive non-generic drugs, a claim not supported by facts which show that 79% of branded medications with available copay assistance do not have a generic equivalent. Still, they began inserting language into insurance plans called “co-pay accumulators,” which allows them to categorize newer specialty medicines as “non-essential,” and then not count the assistance towards a patient’s deductible.

Fortunately, lawmakers in Ohio and Washington, DC are aware of this egregious anti-patient sham — and they’ve begun to act.

Here in Ohio, a bipartisan bill, House Bill 135, was introduced during the last general assembly to ban this practice and make prescription drugs more affordable. The bill passed the House last year but got stuck in the Senate.

And in Congress, the Help Ensure Lower Patient (HELP) Copays Act also gained bipartisan support. But it too has not yet passed.

With these two pieces of legislation, relief for Ohio families is at our fingertips. The time is now for our elected leaders in Columbus and Washington to do what is right and put an end to copay accumulator programs that are putting the health of our families, friends, and communities at risk.

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Jenna McGuinness is a Columbus resident who lives with several chronic health conditions, a chronic bleeding disorder, and has a chronically ill child with respiratory issues.

This commentary was republished from the Ohio Capital Journal under a Creative Commons license.