Commentary: We stepped up in Illinois to help patients better afford the lifesaving prescriptions they need. It is time for the rest of the nation to do the same.
Anyone who has a friend or family member living with chronic illnesses knows the toll these diseases take.
The availability of manufacturer coupons and charitable organizations have traditionally been a way for patients to get access to the care they need at a much lower cost. But that’s changed over the past few years. Increasingly, insurers and pharmacy benefit managers, or PBMs, the insurers’ middlemen, are implementing “copay accumulators,” which enable them to avoid counting patient assistance toward their customers’ annual out-of-pocket maximums, rendering coupon cards useless.
So patients in a plan with a copay accumulator end up paying a lot more in out-of-pocket expenses without hitting the maximum out-of-pocket cost. Even worse, employers and employees often have no idea their plan has an accumulator until employees get hit with an unexpected bill, sometimes for thousands of dollars. Insurers and middlemen hide these terms in their plan documents. Even insurance experts have a hard time spotting accumulators when they review a plan’s paperwork.
While working on this legislation, I heard from people living with HIV, cancer patients and people needing mental health medicine who all had the same story. They needed prescriptions to treat their illnesses, but the copay accumulators were making the cost of their medications unaffordable. Helping these people is why I pushed to get the copay accumulator ban made into law.
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