Rep. Lori Chavez-DeRemer (OR-05) has cosponsored the Help Ensure Lower Patient (HELP) Copays Act – a bipartisan effort to protect patients from harmful insurance and pharmacy benefit manager (PBM) practices that raise patients’ out-of-pocket drug costs.
Specifically, the proposal would prohibit the use of “copay accumulator” schemes that health plans and PBMs developed to pocket a patient’s copay assistance by excluding the cost-sharing assistance from counting towards a patients’ deductible or out-of-pocket maximum. After the copay assistance card runs out, the patients can be hit with surprise four-figure refill bills until the deductible or max is met. This bill would require health plans and PBMs to count the value of copay assistance towards a patient’s cost-sharing requirements, preserving the original intent of the copay assistance program.
“Prescription medications help millions of Americans manage chronic conditions, treat illnesses, and even save lives. Unfortunately, the drug industry’s middlemen often engage in harmful practices that drive up the cost of medication for patients. The HELP Copays Act would address one of these harmful practices – protecting copays to keep out-of-pocket drug costs low for patients. I’ll continue working on commonsense legislation that will help make health care more affordable,” Chavez-DeRemer said.
The proposal mirrors a policy that 16 states and Puerto Rico have already enacted to ensure copay assistance counts towards patients’ out-of-pocket costs. It is being led by Reps. Earl L. “Buddy” Carter (GA-01), Nanette Barragán (CA-44), Mariannette Miller-Meeks (IA-01), and Diana DeGette (CO-01).
Full text of the bill is available HERE.
Chavez-DeRemer is also leading bipartisan legislation that would improve transparency among PBMs and third-party administrators, enabling small businesses to offer more affordable health plans to their employees. The Health DATA Act passed the Education and the Workforce Committee in July.
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