National Patient Organizations Join Forces to Ensure Copay Assistance Counts for Patients

HELP Copays Act Would Protect Treatment Affordability for Vulnerable Patients 

WASHINGTON, Feb. 10, 2023 /PRNewswire/ -- Today, the Immune Deficiency Foundation (IDF) joined 75 national patient and provider advocacy groups that make up the All Copays Count Coalition to applaud the reintroduction of the Help Ensure Lower Patient (HELP) Copays Act, bipartisan federal legislation to ensure vulnerable patients can access and afford the necessary and lifesaving medications prescribed by their doctors. The HELP Copays Act (H.R. 830) would require insurers and pharmacy benefit managers (PBMs) to count the value of copay assistance for covered prescription drugs toward patient cost-sharing requirements in individual, small group, and employer-sponsored health plans. H.R. 830 is championed by a bipartisan group of members of the House of Representatives, including Representatives Earl "Buddy" Carter (R-GA), Nanette Diaz Barragán (D-CA), Brian Fitzpatrick (R-PA), Diana DeGette (D-CO), Mariannette Miller-Meeks (R-IA), Bonnie Watson Coleman (D-NJ), and Yvette Clarke (D-NY).

"IDF has been vocal about the harm copay accumulators pose to patient access to critical medications and has galvanized support for state-level bans across the country, said Lynn Albizo, Vice President of Public Policy at the Immune Deficiency Foundation. "We are pleased to see the HELP Copays Act introduced to fight the same health insurance practice at the federal level. IDF strongly believes that #AllCopaysCount and patients should not be penalized for using assistance programs to afford their medications."

Too frequently, health plans and PBMs have instituted copay accumulator adjustment policies that don't count the value of copay assistance from drug manufacturers and non-profits towards a patient's out-of-pocket maximum or annual deductible. Copay accumulator policies enable plans and PBMs to "double dip" to increase profits and often leave patients with a "copay surprise" at the pharmacy counter when their assistance has run out and they are still responsible for the full amount of their deductible. According to a 2023 report from The AIDS Institute, at least two-thirds (64%) of health plans in the country include a copay accumulator adjustment policy. In 24 states, more than half of all plans include a copay accumulator adjustment policy. A new video from the AIDS Institute explains more about how copay accumulators harm patient access. 

SOURCE Immune Deficiency Foundation