All Copays Count in California Thanks Assembly Member Weber for Introducing Bill to Ensure Assistance Given to Patients Goes to Patients, Not Insurers
Assembly Bill 874 will require that health care plans apply the value of patient assistance to a patient’s deductible and out-of-pocket maximum expenses.
Sacramento, CA (February 16, 2023) – All Copays Count in California, a coalition of more than 75 organizations representing patients, medical providers and health advocates, today thanked Assemblymember Akilah Weber (D-79) for introducing Assembly Bill 874, which will ban the use of copay accumulators to ensure copay assistance reduces patients’ costs instead of increasing profits for insurers.
Copay accumulator programs allow health insurers and Pharmacy Benefit Managers (PBMs) to prevent copay assistance given to patients from counting towards their deductible and maximum out-of-pocket spending.
Copay assistance is provided by drug manufacturers, charitable foundations and other third parties to help patients pay for their prescriptions.
“However, insurers are turning the assistance into more profit for themselves and forcing patients to pay more -in some cases forcing the impossible choice between filling prescriptions or paying their family bills,” said Lynne Kinst, Executive Director of the Hemophilia Council of California.
AB 874 is co-sponsored by the Hemophilia Council of California, the California Rheumatology Alliance (CRA) and the Cystic Fibrosis Research Institute (CFRI). Specifically, the bill would require health insurance plans and pharmacy benefit managers to apply any amount paid by the insured patient through copay assistance to the patient’s deductible or out-of-pocket maximum.
“Assembly Bill 874 is critical to allow patients to access medications that sometimes represent the only treatment that can help them control their disease,” said Dr. Sammy Metyas, president of CRA. “For many of these patients, generic or biosimilar options are simply not available.”
An increasing number of state regulated plans in California has accumulator adjustment programs, many added with little to no notification to patients. Because of this, patients are often unaware of the practice until they go to the pharmacy counter and realize they must pay the full cost of their medication or walk away without it.
“Copay accumulator programs increase health risks and exacerbate health disparities,” said Siri Vaeth, Executive Director of CFRI. “These policies are discriminatory as they disproportionately impact patients who depend on assistance and often have chronic, rare, complex or life-threatening illnesses such as cancer, diabetes, CF, multiple sclerosis, HIV, arthritis, and more.”
Sixteen states and Puerto Rico have already banned the use of copay accumulators. AB 874 will ensure California is next.
The All Copays Count in California Coalition includes the following organizations: Advocacy & Awareness for Immune Disorders Association (AAIDA), AiArthritis, AIM at Melanoma, Allergy and Asthma Network, Alliance for Patient Access- CA Chapter, Alzheimer’s San Diego, American Behcets Disease Association, American Cancer Society Cancer Action Network, CA, Americans for Cures Foundation, Arthritis Foundation, Association for Clinical Oncology, Association of Northern California Oncologists, Autoimmune Association, Axis Advocacy, Breathe Southern California, California Access Coalition, California Association of Physician Assistants (CAPA), California Chronic Care Coalition, California Pharmacists Association, California Rheumatology Alliance, California Urological Association, Carrie’s Touch, Central California Hemophilia Foundation, Coalition of State Rheumatology Organizations, Chronic Care Policy Alliance (CCPA), Chronic Disease Coalition, Crohn’s & Colitis Foundation, Cystic Fibrosis Research Institute (CFRI), Derma Care Access Network, EB Research Partnership, Emphysema Foundation of America, Everylife Foundation, Global Healthy Living Foundation, Hemophilia Council of California, Hemophilia Federation of America, Hemophilia Foundation of Southern California, HIV+Hepatitis Policy Institute, Immune Deficiency Foundation, International Cancer Advocacy Network, Infusion Access Foundation, International Pain Foundation, Liver Coalition of San Diego, Looms for Lupus, Lung Cancer Foundation of America, LUNGevity Foundation, Lupus and Allied Diseases Association, Inc. , Lupus Foundation of America, Male Lupus Warriors Corp, Medical Oncology Association of Southern California, Inc. , Mental Health America California, California Chapter of the National Association of Social Workers, National Eczema Association, National Hemophilia Foundation, National Infusion Center Association, National Multiple Sclerosis Society, National Psoriasis Foundation, Neuropathy Action Foundation, Osteopathic Physicians & Surgeons of California, Ovarian Cancer Coalition of Greater California, Partnership to Advance Cardiovascular Health, People with Empathy, San Francisco Cancer Women’s Network, San Francisco Hep B Free, Spondylitis Association of America, Stanford Copay Coalition, Support Fibromyalgia, Susan G. Komen, The ALS Association, The Defeating Epilepsy Foundation, The Headache and Migraine Policy Forum, The Hemophilia Foundation of Northern California, The Latino Cancer Institute, The Pink Fund, The Wall Las Memorias, Veteran Voices for Fibromyalgia and the We Win Foundation.
About the Hemophilia Council of California
The Hemophilia Council of California (HCC) is an organization formed to create a more effective and unified voice for individuals living with bleeding disorders in California. For more than three decades, HCC has worked to promote access to care and advance the quality of life for people with bleeding disorders through advocacy, education and outreach, in collaboration with its founding organizations across the state.
About the California Rheumatology Alliance
The California Rheumatology Alliance (CRA) is a specialty physician association comprised of rheumatologists from community practices and medical centers throughout the state with a mission to advocate for patient access to rheumatology care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.
About the Cystic Fibrosis Research Institute
The Cystic Fibrosis Research Institute (CFRI) funds innovative cystic fibrosis (CF) research and offers education, advocacy and psychosocial support programs and services to those with CF, as well as their families and caregivers. CFRI engages the CF community, and general public in awareness and advocacy efforts to ensure access to quality care and increased quality of life.