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State Representatives Manchester and West Introduce Patient Protection Legislation
COLUMBUS – State Representatives Susan Manchester (R-Waynesfield) and
Thomas West (D-Canton) recently introduced House Bill 135, which would
cut out-of-pocket prescription drug costs for patients. The legislation
is supported by a large coalition of patient advocate and healthcare
provider organizations.
Some patients with chronic, complex conditions such as multiple
sclerosis and hemophilia rely on copay assistance programs offered
through drug manufacturers, charities, and other third-party
organizations to help cover the costs of their prescription drugs.
Health insurance providers and pharmacy benefit managers (PBMs) have
increased their use of discriminatory policies that disallow payments
made through copay assistance programs to count toward a patient’s
deductible.
These discriminatory practices are referred to as copay accumulator
adjustment policies. Patients impacted by these copay accumulator
policies are often unaware they exist and are blindsided once they
learn these payments did not apply to their deductible. With
accumulators, health plans double their take, by pocketing the
assistance payment and never allowing it to contribute to the
deductible, and then still requiring the full deductible payment to be
made by the patient.
House Bill 135 directs health insurers and PBMs to apply all payments
made by either the patient or on the patient’s behalf through an
assistance program, to count toward a patient’s deductible.
“Copay accumulator policies discriminate against patients with chronic
conditions, as well as those who need innovative prescription drugs for
which no generics typically exist,” said Manchester. “House Bill 135
fights to cut out-of-pocket prescription drug costs for our families.”
House Bill 135 would not interfere with health insurance plans or PBMs
policies to save money by requiring the use of generic medications. The
language specifically states, “…this requirement shall not apply with
respect to cost-sharing for a drug for which there is a medically
generic equivalent.”
House Bill 135 will help Ohioans who are reeling from the pandemic and
will have a lasting effect on patients with rare diseases, saving them
thousands of dollars on prescription costs.
“Insurers and PBMs continue their false narratives about patient
assistance programs. In the midst of a pandemic, this continued attack
on our patients must stop,” said West. “Similar legislation has passed
in five states and Puerto Rico and could be introduced in more than 20
states this year. It’s time we protect Ohio patients, so they have the
opportunity to thrive, not just survive.”
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