Lawmakers Say Copay Assistance Bill Would Lower Patients' Out-Of-Pocket Costs

Jan 23, 2020

Some Ohioans who rely on copay assistance programs to help with expensive medications are finding that their insurance companies are no longer allowing those payments to apply to their deductibles. Two lawmakers are hoping their bill will stop that.

The situation hits people with chronic and complex illnesses very hard, because their meds cost tens of thousands of dollars and there’s usually no generic equivalent.  Democratic Rep. Randi Clites has a son with hemophilia. She isn’t a sponsor, but supports the bill.

“This does disproportionately impact those who are high cost and rare diseases, but this will impact all patient groups who have any copay assistance.”

The bill Republican Rep. Susan Manchester and Democrat Rep. Thomas West say insurers can take the assistance payment and also the patient’s copays – so insurers are essentially getting paid twice for the same drugs. Their bill would require insurance companies to allow copay assistance payments to apply to patient deductibles, which they say would lower patients’ out of pocket costs.

Miranda Motter, president and CEO of the Ohio Association of Health Plans, which represents health insurers working in Ohio, said in a statement:

"PhRMA has been shopping this bill for over a year, and given the public outcry on the high cost of drugs, they have been looking for ways to protect their profit margins.  OAHP cares greatly about the high cost of prescription drugs, and the burden that places upon all healthcare consumers. In fact, OAHP has been raising this issue with legislators and stakeholders over the past few years, and has advocated strongly in support of prescription drug price transparency.  PhRMA uses coupons under the guise of helping patients afford their drugs at the pharmacy counter, but coupons allow PhRMA to hide the true cost of their drugs - costs patients cannot afford but they all pay.”