Commentary: How lawmakers can protect copay assistance

By Matt Prentice

The writer is the director of state policy at the Immune Deficiency Foundation, an organization headquartered in Hanover, dedicated to improving the diagnosis, treatment and quality of life for those affected by primary immunodeficiency.

In the complicated landscape of health care, one thing is abundantly clear — the current drug pricing system is broken. It’s a sentiment echoed by patients, health care providers, insurers, pharmacy benefit managers (PBMs), manufacturers, and researchers alike.

The system, as it stands, fails to serve anyone’s interests adequately, least of all the patients who bear the brunt of its shortcomings at the pharmacy counter. This legislative session in the Maryland General Assembly, the Immune Deficiency Foundation, a national patient organization headquartered in Hanover, has led a coalition of organizations to push for immediate relief for patients caught in the crossfire of exorbitant drug prices.

The proposal put forth by the All Copays Count Coalition, embodied in Senate Bill 595/House Bill 879, seeks to ensure that all payments made by patients — whether directly or on their behalf — are counted towards their health insurance deductibles and out-of-pocket maximums. By mandating that health insurers and PBMs include all payments, this legislation aims to shield Marylanders from surprise bills and treatment delays and ensure they benefit fully from copay assistance programs.

The crux of the issue lies in copay accumulator policies, which disallow copay assistance program payments from counting towards deductibles or out-of-pocket maximums — a loophole often buried deep in insurance plans. This practice has become increasingly common across the United States, leaving patients vulnerable to unexpected bills and financial strain.

During the hearing process, one Maryland mother shared the harrowing ordeal of receiving a communication from her insurer for the same amount a copay assistance program had already covered. Megan Waranch resides in Owings Mills with her husband and two children. Her youngest son has hemophilia, a rare genetic bleeding disorder. There are no generic or low-cost options for her son’s treatment and copay assistance provides her family the ability to afford his lifesaving treatments.

After her insurer received thousands in copay assistance, she was told that the assistance was not applied, and she would be required to pay the entire deductible and out-of-pocket maximum. Sadly, stories like hers are all too common, illustrating the urgent necessity of legislative action to protect patients.

It’s no secret that insurers and PBMs have vehemently opposed this legislation, attempting to derail it at every turn. Insurers and PBMs take issue with copay assistance from drug manufacturers stating that the real issue is the price of drugs. However, copay accumulator policies only hurt patients who want to access the medication their doctor has determined is best for them. Amendments introduced in the House of Delegates have sought to gut the bill, raising serious concerns about the motives behind these actions.

While our coalition has worked tirelessly to salvage the bill, troubling amendments persist in HB 879 that threaten to undermine its efficacy in helping patients. Despite the challenges, we remain steadfast in our commitment to advocating for patients and ensuring they have access to affordable medications.

We recognize the complexity of this issue and are prepared to engage with all stakeholders, including elected officials, to address concerns and find viable solutions. We are immensely grateful to those who have listened to our patients’ stories and championed their cause, particularly Sen. Steve Hershey (R-Upper Shore) and Del. Steve Johnson (D-Harford), the lead sponsors of the introduced bills.

At its core, this legislation is about helping the patients afford their medications and access the financial assistance they desperately need. Copay assistance is not a luxury; it’s a lifeline for patients who have no other option but to shoulder the burden of exorbitant healthcare costs.

As we continue to advocate for patients, we urge policymakers to stand on the side of compassion and fairness. It’s time for Maryland to join the ranks of states that have taken decisive action to protect patients from the harmful effects of accumulator policies. Nineteen other states, along with the District of Columbia and Puerto Rico, have already passed accumulator bans.

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