Too many patients across Virginia are struggling to afford the health care they need, particularly the patients with chronic and complex conditions who come into their physician’s office every day. Unfortunately, patients are increasingly losing access to a critical lifeline that many rely on to help meet the high cost of care.

Copayment assistance cards or coupons are one way that pharmaceutical manufacturers help patients defray their out-of-pocket costs by covering the cost of medicines that patients rely on before they reach their annual deductible and their insurance kicks in.

But, unbeknownst to many patients and providers, health insurers are increasingly deploying a new tactic to undercut the benefit of these assistance programs. Known as “copay accumulator adjustment programs,” these measures — often buried in insurance plan fine print — prevent patients from counting the value of their copay assistance benefits toward their annual deductible, as patients have been able to do in years past.

While this might seem like a minor change, it has a huge impact on the patients who rely on copay assistance programs. As a result, patients have begun showing up at the pharmacy counter expecting to be able to pick up their medication as they normally would, only to find that they must pay thousands of dollars out-of-pocket — or even having to pay the full cost of their deductible at once.

Until they pay, their medication is held hostage, putting otherwise stable patients at risk of being forced to discontinue treatment for severe, even life-threatening conditions because they simply cannot afford to pay out-of-pocket maximums that can be thousands of dollars.

Fortunately, new legislation in Virginia, House Bill 2515 and Senate Bill 1596, requires that any payment made toward a patient’s cost of care — whether because they paid out-of-pocket or used a copay assistance program — would count toward his or her deductible. With nearly 1 in 5 major employers already using copay accumulator adjustment programs, and with more expected to follow, this legislation is both critical and timely.

The legislation recently passed the General Assembly, and as of this writing is awaiting the governor’s signature.

As out-of-pocket costs continue to rise, Virginia patients already face enough barriers to accessing the health care coverage that they need. Copay assistance programs are a critical resource, particularly for patients whose health care costs could bankrupt their families or force them to live without the care they need.

These patients should not be denied one of the key benefits of copay assistance programs, particularly since insurers are already getting the value of negotiated drug price discounts while withholding these benefits from patients.

Dr. Bruce A. Silverman is a nephrologist in the metro-Richmond area and is an advocate for the Fair Health Care VA Coalition.

Load comments