National Coalition Applauds Bipartisan Federal Legislation to Ensure Copay Assistance Counts for Patients

HELP Copays Act Would Protect Treatment Affordability for Vulnerable Patients

WASHINGTON, DC – February 9, 2023 —Today, 75 national patient and provider advocacy groups that make up the All Copays Count Coalition applauded the reintroduction of the Help Ensure Lower Patient (HELP) Copays Act, bipartisan federal legislation to ensure vulnerable patients can access and afford the necessary and life-saving medications prescribed by their doctors. The HELP Copays Act (H.R. 830) would require insurers and pharmacy benefit managers (PBMs) to count the value of copay assistance for covered prescription drugs toward patient cost-sharing requirements in individual, small group, and employer-sponsored health plans. H.R. 830 is championed by a bipartisan group of members of the House of Representatives, including Representatives Earl “Buddy” Carter (R-GA), Nanette Diaz Barragán (D-CA), Brian Fitzpatrick (R-PA), Diana DeGette (D-CO), Mariannette Miller-Meeks (R-IA), Bonnie Watson Coleman (D-NJ), and Yvette Clarke (D-NY).

“The HELP Copays Act represents a bipartisan, commonsense solution to improve patient access to their prescription medications and rein in notoriously opaque policies and practices that plans and PBMs use to pad their bottom lines,” said Rachel Klein, Deputy Executive Director at The AIDS Institute, a steering committee member of the All Copays Count Coalition. “Our Coalition stands ready and eager to work with these patient champions to advance this legislation that will make a meaningful difference to help patients afford the medications they need.”

Too frequently, health plans and PBMs have instituted copay accumulator adjustment policies that don’t count the value of copay assistance from drug manufacturers and non-profits towards a patient’s out-of-pocket maximum or annual deductible. Copay accumulator policies enable plans and PBMs to “double dip” to increase profits and often leave patients with a “copay surprise” at the pharmacy counter when their assistance has run out and they are still responsible for the full amount of their deductible. According to a 2023 report from The AIDS Institute, at least two-thirds (64%) of health plans in the country include a copay accumulator adjustment policy. In 24 states, over half of all plans include a copay accumulator adjustment policy. A new video from the AIDS Institute explains more about how copay accumulators harm patient access.

“IDF has been vocal about the harm copay accumulators pose to patient access to critical medications and has galvanized support for state-level bans across the country, said Lynn Albizo, Vice President of Public Policy at the Immune Deficiency Foundation. “We are pleased to see the HELP Copays Act introduced to fight the same health insurance practice at the federal level. IDF strongly believes that #AllCopaysCount and patients should not be penalized for using assistance programs to afford their medications.”

The HELP Copays Act eliminates barriers to care by:

  • Requiring health plans to count the value of copay assistance toward patient cost–sharing requirements; and
  • Ending an insurer/PBM practice classifying certain medications as “non–essential” to avoid out–of–pocket maximums

There is growing support for federal policy efforts to ensure copay assistance counts toward patient costs.

  • States Are Taking Similar Action to Ensure Copay Assistance Counts. To date, 16 states and Puerto Rico have already enacted policy to ensure copay assistance counts towards patients out-of-pocket costs.
  • Copay Assistance Reduces Costs and Improve Health Outcomes. From 2015-2020, Out-of-pocket (OOP) costs in the commercial market declined by 6.3% due to the use of copay assistance leading to $12 billion in OOP savings for patients. Copay assistance increases drug utilization which leads to 1.0 to 3.3% better health outcomes.
  • Americans Believe the Government Should Ensure Copay Assistance Counts. According to a National Hemophilia Foundation survey, more than 80 percent of voters political parties believe the government should require copay assistance to be applied to patients’ out-of-pocket costs.

About the All Copays Count Coalition
The All Copays Count Coalition (ACCC) is comprised of members serving the interests of beneficiaries with chronic and serious health conditions that rely on copay assistance in various forms to make medically necessary drug treatments affordable. The coalition provides information about the harmful effects of pricing schemes, known as “copay accumulators and maximizers,” on access to prescription drugs for people with chronic and serious health conditions.

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Additional Coalition Member Quotes:

“The ALS Association strongly supports the Help Ensure Lower Patient Copays Act (HELP Copays Act which requires that people with ALS and other serious conditions receive full credit for all possible co-payments to help them secure costly life-saving medications. People with ALS face a devastating neurodegenerative disease and should not be victims of schemes to cheat them of co-pay assistance. This bill is much needed to ensure fairness for people with ALS, others with serious disorders and their families who face tremendous health and financial challenges.” – Melanie Lendnal, Esq., Senior Vice President, Policy and Advocacy, ALS Association

“We urge the House to pass the HELP Copays Act in order to support millions of their constituents who are living with cancer and other chronic health conditions. When an insurer chooses not to apply pharmaceutical company co-payment assistance to a consumer’s health insurance deductible and out-of-pocket maximum, the result is another devastating blow dealt to someone who has already been diagnosed with a life-altering illness. Patients rely on co-payment assistance to reduce the financial strain of a diagnosis. Saving money on the cost of medicine frees up money to be used for a patient’s daily living expenses, especially at a time when a patient’s ability to earn money may be compromised. Congress must ensure this crucial support intended for patients actually reaches them and is not redirected to insurance companies.” – Amanda Goodstadt, Staff Attorney, Triage Cancer

“The PAN Foundation thanks Rep. Buddy Carter (R-GA) and Rep. Nanette Barragan (D-CA), along with their original co-sponsors, for introducing H.R.830—the bipartisan Help Ensure Lower Patient (HELP) Copays Act—in the House of Representatives. Far too many patients across the country, especially those with life-threatening, chronic, and rare diseases, face high out-of-pocket prescription costs leading them to delay or go without essential medical care. By ensuring all payments, including those received through copay assistance programs, count toward their out-of-pocket costs, this bill will help make it so that patients don’t have to choose between their much needed medications or putting food on the table. PAN is committed to advocating for improved healthcare access, affordability, and equity so that people can live the lives they deserve.” – Amy Niles, Chief Advocacy and Engagement Officer, Patient Access Network (PAN) Foundation

“Copay accumulator and maximizer policies cause grave hardship for those who can least afford it — the chronically ill and low-income,” says Laura Wingate, executive vice president, education, support, and advocacy, Crohn’s & Colitis Foundation. “The HELP Copays Act makes great strides in alleviating the concerns of the Crohn’s disease and ulcerative colitis community by ensuring that our most vulnerable patients maintain access to their life-saving medications.” – Laura Wingage, Executive Vice President, Education, Support and Advocacy, Crohn’s & Colitis Foundation

“ASCO strongly supports the Help Ensure Lower Patient (HELP) Copays Act, which would help eliminate barriers patients face when trying to access lifesaving, doctor prescribed medications. Currently, patients bear the unnecessary burden of rising out-of-pocket prescription drug costs due to copay accumulator adjustment and copay maximizer programs. The HELP Act would greatly help cancer patients, especially those with limited financial resources, to ensure they can access and afford high-quality, equitable cancer care.” — Lori J. Pierce, MD, FASTRO, FASCO, Chair of the Board, Association of Clinical Oncology