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Patients’ Financial Assistance Under Attack

Many people rely on assistance programs, including co-pay cards, to help pay for their medications. But this vital form of financial relief is under widespread attack, a new report finds.

A comprehensive review of marketplace health plans conducted by The AIDS Institute found that co-pay accumulator adjustment programs have become all too common. These programs prevent patients’ co-pay cards from counting toward their annual deductibles and out-of-pocket drug costs. The practice effectively shifts costs from insurers to patients – often without patients’ knowledge.

Findings reveal that health insurance plans in 35 states include a co-pay policy that undermines patients’ ability to get their medicine. In eight states, every single marketplace plan includes this harmful practice, leaving the patient with no alternative.

And that can be a dangerous situation. Co-pay cards often help patients with chronic, complex and rare diseases afford their medications and remain adherent to prescribed treatments.

Not only can patients be overwhelmed by exorbitant out-of-pocket costs, but they may be unable to determine up front if their health plan includes such a policy. The report shows insurers fail to transparently disclose this information, burying the language in complicated plan details.

While the AIDS Institute specifically investigated marketplace plans, commercial plans can have a similar policy.

Reform Could be Eminent

Patients, providers and advocates are sounding the alarm on harmful co-pay programs, calling for patient-protection reforms or total bans on their use. Policymakers across the country are taking note. 

Twelve states have laws that require insurance companies to count co-pay assistance toward enrollees’ deductibles and out-of-pocket limits. And at least 17 state legislatures introduced legislation in 2022.

Calls for federal regulation are also mounting. Representatives Donald McEachin (D-VA) and Rodney Davis (R-IL) introduced the HELP Copays Act. The bill requires insurers to include co-pay assistance in the calculation of patients’ total out-of-pocket costs. 

Just as the use of co-pay coupons has been increasing, so has the use of policies to keep patients from reaping their benefit. It’s time to limit their harm and ensure patients have access to their necessary medications.

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