While Utah has been able to navigate COVID-19 far better than many other states, we are still facing some of the side effects of the pandemic. And with inflation at a 40-year high, it is critical that we look at new ways to ease the financial burdens for those impacted by chronic disease.
Medical advances have increased exponentially over the past two decades. There are new therapies and medications for treating life-threatening illnesses like ALS, cancer, lupus and hemophilia. In fact, the FDA just approved a new drug that can be administered to multiple sclerosis patients only twice a year that cuts down the rate of relapse to just once in 10 years.
This is an incredible advance in combating the most common disease of the central nervous system in young adults, affecting nearly 1 million Americans over the age of 18. Other good news includes a new therapy for the thousands of Americans suffering from cystic fibrosis that appears to treat the underlying cause of the disease.
However, these cutting-edge medical treatments aren’t cheap. Health insurance companies and pharmacy benefit managers who negotiate drug prices have found a disingenuous new way to pad their bottom line by shifting more of the cost onto patients.
One of the most widely used tools patients had to help pay for their medicine was receiving funding from nonprofits and pharmaceutical manufacturers called “copay assistance savings programs.” These programs helped reduce out-of-pocket payments for medication and medical treatment. The intent was that the savings provided by these programs would go towards a patient’s insurance deductible, with insurance covering the rest of the cost.
Unfortunately, a few years ago, the insurance companies and pharmacy benefit managers chose to exploit a loophole in our laws and began categorizing new innovative medical treatments as “nonessential.”
Why the mischaracterization? Because insurers don’t need to count third-party assistance for “nonessential” drugs towards their patient’s deductible but would have had to otherwise. Of course, insurers are still more than happy to accept payments from these assistance programs, but they now force patients to pay thousands more before reaching their out-of-pocket maximum.
The result is that insurers and pharmacy benefit managers now pocket thousands more, all while leaving chronically ill patients in the lurch.
Few are aware of this practice because most patients impacted don’t know that their health plan contains a “co-pay accumulator” or “maximizer program” until they get hit with a surprise bill showing that they owe money — after they thought they had paid their deductible. This is an understandably horrifying realization for patients, which is compounded by the realization that they may no longer be able to afford life-saving treatment.
This is exactly why I have introduced SB184, Prescription Cost Amendments, which will update Utah laws to prohibit insurers and pharmacy benefit managers from continuing this practice. It will help patients afford the very lifesaving medications they need to manage the chronic illnesses with which they are struggling.
I’m also pleased that Congress has a bipartisan bill, HR5801, the Help Ensure Lower Patient Copays Act, that would fix federal laws on this issue, protecting patients and doing at the federal level what I am trying to do at the state level.
SB184 will help individuals suffering from chronic disease and struggling to pay for treatments.
State Sen. Curtis Bramble is a Republican representing District 24.