Please join the Michigan All Copays Count Coalition for the MACC Legislative Advocacy Day on September 14 to help pass House Bill 4353, legislation in support of helping patients pay for life-saving medication. On the day of its committee hearing, MSDC and coalition partners sent a letter to Chair Vincent Gray supporting B24-557, the Copay Accumulator Amendment Act. Patients are facing yet another barrier in the form of new copay accumulator. The coalition is currently asking the Michigan Senate to pass House Bill 4353, which would accomplish this much-needed accumulator reform, but they need your help. According to Avalere Health, a healthcare consulting firm in Washington, D.C., more than 80 of the people covered by commercial insurance belong to plans that have implemented a copay accumulator and more than 70 are in plans with copay maximizers, a version of the accumulators designed to even out patient out-of-pocket costs. Many states have already introduced legislation in 2022. That is why MSMS joined the Michigan All Copays Count (MACC) Coalition, which was created in March 2021 to support legislation that will guarantee insurance companies count copay assistance towards patients’ out-of-pocket costs. All insurers in Michigan use some form of this practice and without reform, this trend will continue increase. Unfortunately, insurers continue to introduce programs like copay accumulator adjustment programs, which bar all copay assistance from counting towards patients’ out-of-pocket costs, creating further barriers to life-saving treatments and access to care. Due to these high costs, many patients and their families rely on copay assistance programs commonly provided by manufacturers and non-profit organizations to afford the medications they need to manage their conditions. 1, 2024, about 13% of the commercial payer market will be operating under laws that ban accumulators.Every day, physicians see patients with rare and chronic conditions like cancer, multiple sclerosis, hemophilia, and rheumatoid arthritis, which often require high-cost treatments that rarely have generic alternatives. Several states have now passed legislation that prohibits the use of copay accumulator adjustment programs (CAAP), or accumulator adjustment programs. The bans are not just nibbling at the edges. According to Avalere, as of January 2023, 16 states (Arizona, Arkansas, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, New York, North Carolina, Oklahoma, Tennessee, Virginia, Washington and West Virginia) had banned accumulators in state-regulated health plans. State regulators and legislatures have also gotten involved. The use of co-pay accumulators is growing rapidly, from 44 of Americans commercial health insurance policies in 2018 to 80 in 2021, said Adam Fein in his Drug Channels blog. In August 2022, three patient groups - the HIV and Hepatitis Policy Institute, the Diabetes Patient Advocacy Coalition and the Diabetes Leadership Council - filed a lawsuit challenging a Trump administration decision that allowed pharmacy benefit managers to continue to use accumulator and maximizers. Many patient groups and professional organizers are opposed to accumulator programs. A copay accumulator, also known as an accumulator adjustment scheme, is used to prevent manufacturer copay assistance coupons used by insurance companies and pharmacy benefit managers (PBMs) from being utilized to cover two prices: the maximum amount you must pay out of pocket. In addition, co-pay accumulators undo the long-term benefits of co-pay assistance programs. They have pushed back with “copay adjustment programs,” especially “copay accumulators,” which are designed to blunt the effect of the copay assistance programs by not counting their value toward patient deductibles.Īccording to Avalere Health, a healthcare consulting firm in Washington, D.C., more than 80% of the people covered by commercial insurance belong to plans that have implemented a copay accumulator and more than 70% are in plans with copay maximizers, a version of the accumulators designed to even out patient out-of-pocket costs. Requiring co-pay assistance to count prevents insurance providers from effectively collecting deductibles or out-of-pocket maximums twice once from the third-party assistance program and again from the patient’s pocket when the assistance runs out. But pharmacy benefit managers have cried foul, saying the copay programs undercut formularies and wind up increasing the use of expensive drugs that are not any better than less expensive ones. to state legislatures in 2021, 2022, and again in 2023 are co-pay accumulators. Georgia and Oregon passed prior authorization reform. Five states passed step therapy reform, bringing the total to 30. Seven states passed copay accumulator legislation, meaning 11 states now have accumulator bans. Drugmakers use copay assistance programs to shield patients from out-of-pocket expenses - and build market share for their products in the process. In 2021, we made significant strides for ACR members at the state level.
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