Take 2 minutes and complete this form to ask your members of Congress to support the HELP Copays Act.
The Cancer Support Community supports H.R. 830/S. 1375, the Help Ensure Lower Patient Copays (HELP Copays) Act, and similar state legislation to ban copay accumulator adjustment programs that prohibit manufacturer copay assistance from being counted toward a patient’s annual deductible and/or maximum out-of-pocket cost sharing requirements.
These “schemes” allow insurers and pharmacy benefit managers (PBMs) to essentially take advantage of vulnerable patients by pocketing the assistance the patient is using but not counting the value towards the patient’s cost-sharing requirements. Worse, by deferring rather than defraying the prohibitive cost of treatment, these policies leave patients who exhaust their prescription assistance options, no closer to reaching their insurance deductibles while still facing the same, exorbitant prescription drug costs at the pharmacy counter.
PBMs have also found a way to avoid assigning out-of-pocket maximums for patients with complex medical conditions whose treatments are often unaffordable by classifying these lifesaving medications as non-essential. In doing so, patients are required to rely on copay assistance to access their treatments.
HELP Copays Act:
- Requires health plans to count the value of copay assistance toward patient cost-sharing requirements.
- Ensuring that all payments — whether they come directly out of a patient’s pocket or with the help of copay assistance — count towards their out-of-pocket costs.
- Close a loophole under the Affordable Care Act that allows many employer health plans to deem certain categories of prescription drugs as “non-essential,” even when they are life-saving or necessary for people with serious pre-existing and chronic conditions.
- When a covered drug is deemed “non-essential,” the insurer will not count any cost-sharing toward the patient’s deductible and out-of-pocket maximum.