Assembly Bill 2180 Would Ensure California Health Plans and PBMs Count Copay Assistance Towards Patient Cost-Sharing Requirements

SACRAMENTO, CA, April 23, 2024 – Today, patient and provider advocates from the All Copays Count in California Coalition testified in front of the California State Assembly Committee on Health to call on members of the California State Legislature to support legislation (AB 2180) that would help California patients access and adhere to their prescription medications. If passed, AB 2180 will ensure that commercial health plans and PBMs in California count the value of copay assistance toward patient cost-sharing requirements. Additionally, AB 2180 would ensure that cost-sharing for any covered item or service within one of the Essential Health Benefits (EHB) categories of the Affordable Care Act counts toward cost-sharing requirements.

“The All Copays Count in California Coalition commends the Assembly Committee on Health for supporting legislation that will improve patient access to medications and protect the most vulnerable Californians from harmful and deceptive insurance schemes that raise patient costs.” said Lynne Kinst, Executive Director of Hemophilia Council of California, which is a cosponsor of the bill.

Increasingly, commercial health plans across California and the nation are implementing copay accumulator adjustment policies that don’t count the value of copay assistance toward a patient’s annual deductible or out-of-pocket maximum. These policies allow health plans to increase their profits by requiring patients to pay the same amount after the plans have already collected third-party payments made on the patients’ behalf.  A 2023 report from The AIDS Institute found that nearly 50% commercially available insurance plans in California are implementing copay accumulator policies.

A recent analysis from the California Health Benefits Review Program (CHBRP) notes that this legislation would have a positive impact on patient adherence to treatment, would improve health equity in the state, and would improve the health outcomes of patients who would not have otherwise received treatment.

To date, 20 states, Washington, DC, and Puerto Rico have passed legislation that requires health insurers to count the value of copay assistance towards patient’s cost-sharing responsibilities, including Arizona, Arkansas, Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Maine, New Mexico, New York, North Carolina, Oklahoma, Oregon, Tennessee, Texas, Virginia, Washington, and West Virginia.

About the All Copays Count in California Coalition:
The All Copays Count in California Coalition is comprised of national and California-based patient, provider, and physician groups serving the interests of patients with chronic and serious health
conditions that rely on copay assistance to access critical medications.