Paying for health care can be a tireless and stressful journey for many Arizonans, especially those of us with chronic conditions. We’ve all heard about surprise medical bills or out-of-network surcharges that can cripple one’s budget and cause massive strains on one’s bank account.
In many states, even when patients get help paying for their treatment, the insurance companies and Pharmacy Benefit Managers (PBMs) exploit loopholes, putting the patients back to square one. Such is the case with copay accumulator adjustment programs, also called CAAPs.
CAAPs serve the nasty business of disallowing copay assistance programs for prescription medications to count toward a patient’s deductible/out-of-pocket maximum. Thanks to today’s complicated world of drug pricing, copay assistance programs have come to serve as a necessity when it comes to paying for prescription medications.
These are the types of programs you hear about on TV commercials when the narrator says, “If you need help paying for your medication, [insert company] may be able to help!” There are also several charitable organizations nationally and locally that offer copay assistance programs. Sadly though, insurance companies in the past decade have decided to institute CAAPs to maximize their profits on the backs of patients. It’s a deceitful and despicable practice.
Luckily, we here in Arizona were one of the first to ban these copay accumulator adjuster programs. In 2019, HB2166 was passed in the Arizona House. This piece of legislation banned the practice of accumulator adjustment programs and required a health care insurer to include any cost-sharing amount paid by either the patient or another person on behalf of the covered patient to count toward the patients’ deductible or other out-of-pocket costs.
Put simply, it ensured that if a patient used a coupon to reduce the cost of their prescription from $200 to $50, that the full $200 cost of the prescription would be applied to the patient’s deductible. The bill was met with unilateral support in both chambers by both parties. It passed out of the House 57-0 and passed out of the Senate 29-0. Also, the bill had a wide range of support from the patient community, with many state and local patient groups supporting and/or testifying on the bill’s behalf. It was a success that Arizona legislators should be proud of.
Now comes the time for our congressional leaders to step up and do the same. The bipartisan HELP Copays Act would prohibit the use of “copay accumulator” schemes on the national level. The fact that a bill like this, in today’s divided political environment, would have support from both Democrats and Republicans shows how badly America needs this fix. Furthermore, it has the strong backing of dozens of national patient groups such as the ACS-CAN, the Cancer Support Community, the Arthritis Foundation and the National Hemophilia Foundation, just to name a few.
Our organization, the Arizona Prostate Cancer Coalition, knows first-hand about patients often requiring ongoing medical care and prescription drug treatment. Costs can quickly escalate over time, especially with chronic conditions like cancer. The HELP Copays Act nationally provides relief that patients need to better manage their disease and avoid falling into financial despair.
I’ve contacted my congressional representative and senators and asked them to co-sponsor this important bill. I truly hope other Arizonans will do the same.
Bruce Williams is president of the Arizona Prostate Cancer Coalition.