Ohio Bill To Help Health Insurance Copays Gets Life

Columbus Dispatch (OH)

Many drug manufacturers provide coupons or other financial aid to help consumers meet copays (including deductibles or co-insurance) for typically expensive drugs needed to combat rare ailments.

A bipartisan bill that would help patients meet health insurance copays may finally move after sitting dormant for more than a year following unanimous passage by the Ohio Health Committee.

A Dispatch story earlier this month described how House Bill 135 was mysteriously stalled after questions were raised by Cincinnati Rep. Bill Seitz, the No. 3 GOP House leader. Dozens of advocacy groups – such as the American Cancer Society, The AIDS Institute, and Ohio State Medical Association – support the measure. Only organizations representing health insurers and pharmacy benefit managers openly opposed the bill.

The proposal – taking an unusual route of being re-referred to the Rules and Reference Committee, which is directly run by House leaders – likely will get an innocuous amendment and pass the chamber, insiders say. The vote could come as soon as Wednesday.

The plan would effectively ban copay accumulators in Ohio, joining more than a dozen states and Puerto Rico. This tactic represents a relatively new maneuver by health insurers that targets pharmaceutical companies, but often catches patients in the crossfire.

Many drug manufacturers provide coupons or other financial aid to help consumers meet copays (including deductibles or co-insurance) for typically expensive drugs needed to combat rare ailments. However, most health insurers now decree that consumers cannot count that drug-maker aid toward their insurance policy's annual maximum for copays/deductibles or out-of-pocket spending.

"Accumulators reduce the (health insurer's) cost by shifting more of a prescription's expenses to patients and manufacturers, because the (insurer) effectively captures the value of two deductibles," says analyst Adam Fein.