Matt Lesser

State Senator Matt Lesser Leads Discussion and Passage of Bill that Prohibits Insurers from Implementing Copay Accumulator Programs

Today, state Senator Matt Lesser (D-Middletown), Chair of the Insurance & Real Estate Committee, led debate over Senate Bill 1003 that unanimously passed, 36-0, on the Senate Floor. This bill would prohibit insurers from implementing Copay Accumulator programs. A copay accumulator is a strategy used by insurance companies and Pharmacy Benefit Managers (PBMs) that stop copay assistance coupons from counting toward a patient’s deductible. These programs use patients as hostages in the battle of insurers and pharmacy benefits managers versus pharmaceutical companies.

“It’s outrageous that insurance companies are now trying to claw back coupons and rebates issued by drug manufacturers,” said Sen. Lesser. “Banning copay accumulators is a way to provide much needed relief to consumers facing skyrocketing drug prices. I was pleased to lead debate on this bipartisan health reform legislation that passed unanimously.”

Senate Bill 1003, An Act Prohibiting Certain Health Carriers And Pharmacy Benefits Managers From Employing Copay Accumulator Programs, would require certain health carriers and pharmacy benefits managers to give credit for payments made by third parties for the amount of, or any portion of the amount of, an insured’s or enrollee’s cost-sharing liability for a covered benefit.

While the high price of prescription drugs is an enormous problem, the answer to this problem is not taking more money from patients. According to Geoffrey Joyce, a pharmaceutical economist at the University of Southern California, “There are no good guys here, this is about control of the market. The only thing that’s clear is who loses. The loser is the patient.”

Copay Accumulators have been present in the specialty pharmacy space for oral drugs for some time, causing many challenges for chronically ill patients as they fall under financial hardship. This hardship can increase the likelihood of treatment non-adherence and can ultimately lead to advanced disease state. Additionally, patients who continue treatment may incur significant debt for long term costly treatments.

Under Copayment Accumulator programs, any copayment assistance that a patient receives, whether it be directly from a pharmaceutical manufacturer or from coupon cards such as Good RX, it does not count toward the patient’s deductible. Patients must spend more out of pocket to reach their deductible, sometimes thousands of dollars more. For too many patients, this makes the drugs they depend on unaffordable.

It appears that these programs may allow insurers to double dip because they get their full co-pays while also extending the duration of patients’ deductibles. Connecticut should protect its residents from this practice.

Several organizations in our state support this bill including, the American Cancer Society, the Connecticut Hemophilia Society, the National Multiple Sclerosis Society, the Connecticut State Medical Society, the American Kidney Fund, and the Epilepsy Foundation. All these organizations support the bill many patients depend on financial assistance for their specialty medications and a person with health care issues will spend much more out of pocket cost than the average person. If a patient has to spend more money on their medications, patients are known to skip dosages, split pills and stop taking their medication entirely. This can cause serious health concerns and reduces the effectiveness of their treatment.