Denying drug-cost assistance hurts patients
In October 2018, I received a bill for $2,326.24 for an MRI. MRIs are a regular test for multiple sclerosis patients like me and my mother to help track the status and any progression of our disease.
I thought the bill must have been a mistake. I had a statement from my health insurer showing I had already met my deductible for the year. I could not understand why I was being billed this large amount when I always meet my deductible with the cost of my monthly prescription medications.
My insurance company informed me that the financial assistance I had received from my drug company to help pay for my medication was no longer being counted toward my deductible. This new rule had been buried in the fine print of my health insurance policy, and I was not aware of the change. There is a wide variety of names for these discriminating policies, but most are referred to as copay accumulators.
As a newlywed, it was important for my husband and I to organize our finances as a couple, so needless to say we were both upset to receive this unexpected bill and others that followed. Even with us saving for a rainy day, there was no way we could plan for $4,000 in unexpected costs.
Copay accumulator programs are used by insurers to stop prescription drug coupons or other forms of charitable assistance from applying toward a patient’s annual deductible or out-of-pocket maximum amounts, even though the insurers are receiving full payment for the medication.
It is frustrating that insurers get to keep both the assistance payment and any copays paid directly by me while in the deductible phase — it is a double-dip that jeopardizes the health of patients.
My annual medication costs are over $100,000 and not being able to use any patient assistance toward my co-pay is a financial hardship to say the least. I have health insurance through my employer. A person with MS spends three times as much on out-of-pocket costs than the average person with an employer plan, and our medications
are 75 percent of the costs to
Insurers claim that they no longer allow coupons because it encourages physicians and patients to use more expensive name-brand medications, and encourage generics. Medicines such as the ones I use are critical to slow the progression of my MS. There are very few medications to treat our illness — currently approximately 20 brand-name and only three generics.
Insurers should not be allowed to discriminate against MS patients like me with copay accumulator adjustor policies just because most of our medications are name brand. Almost 40 percent of people living with MS rely on some form of copay assistance to have access to their disease-modifying therapy.
Patients with chronic and complex conditions face significant financial hardship each year until their deductibles have been met and their health insurance benefits apply.
By stretching out our deductibles, other needs such as MRIs, doctors’ visits, physical therapy and other medications are financially out-of-reach. Patients are forced to be less adherent to their drugs and face worse health outcomes — costing everyone more in the long run.
Ohio House Bill 469 is currently being considered in the House Health Committee. The bill directs insurers to accept all forms of payments toward deductibles, whether a manufacturer coupon, a church or civic donation, or help from friends and family. What the bill does not do is get in the way of insurers requiring a patient to use a generic version of a medication if one is available. Ohioans need all forms of payment, regardless of where it comes from, to count toward our out-of-pocket deductibles.
Patients like me, my mom, and the 1 million other Americans fighting MS need relief from the escalating price increases for our medications and out-of-pocket costs. This is especially true considering the economic losses from the pandemic. We need improved access to our treatments, not a decrease in the critical assistance available.
The passage of HB 469 would be a strong step in the right direction.
Nikki Snyder is a resident of Canfield. She and her mother both are living with MS.