Tom Wright, Lindsay Cross file bills cracking down on ‘copay accumulators’

Republican Sen. Tom Wright and Democratic Rep. Lindsay Cross have filed legislation requiring copay assistance payments to count toward patients’ health insurance deductibles.

The bills (SB 228/HB 363) specifically target “copay accumulators,” which are copay assistance payments accepted by pharmacy benefit managers (PBMs) and insurance companies on behalf of patients but do not apply to deductibles, out-of-pocket maximums, or co-payment responsibilities.

The legislation would require that all money paid to PBMs and insurance companies for prescription drugs be applied to a patient’s deductible, out-of-pocket maximum, and co-payment responsibility no matter who paid.

“Regardless of where it comes from, money accepted by PBMs and insurance companies for prescription drugs should count toward the patient’s deductible and out-of-pocket maximum. PBMs and insurance companies should not be allowed to double-dip at the expense of patients who are struggling with chronic illness,” Wright said.

Cross added, “I’m incredibly proud to be sponsoring this patient-focused legislation because Floridians deserve financial relief for costly prescriptions. Patients with chronic or life-threatening illnesses often rely on innovative medicines to prolong and improve their quality of life. It is disingenuous for insurance companies and PBMs to profit from copay assistance without passing on the benefits to patients. This bill will help patients get the life-saving care they need at a cost that they can afford.”

Copay assistance is a common tool for patients with chronic illnesses treated with higher-priced drugs, such as AIDS, hemophilia and multiple scleroris, and the legislation is likewise receiving early backing from groups representing those patients.

“Insurers have been allowed to manipulate the patient assistance system to profit from funds intended to benefit patients. In 2022, nine out of 12 plans in Florida had these policies, leaving patients living with chronic illness few choices,” said Donna Sabatino, an RN and ACRN with The AIDS Institute Tampa.

“Florida should pass the Double Dipping Bill, joining the 19 other states (plus Washington D.C. and Puerto Rico) that now protect access to medications needed for people living with chronic illness. This is a commonsense bill that will require insurers and PBMs to count payments they receive on behalf of a patient toward that patient’s cost-sharing requirements.”

Hemophilia Federation of America Senior Manager for Policy Mark Hobraczk said copay assistance is the only way many patients with hemophilia can afford their drugs, and there aren’t lower-cost alternatives for treatment.

“Florida health plans should never be allowed to pocket that copay assistance for themselves and threaten patients’ health,” he said.

National Multiple Sclerosis Society Senior Manager of Advocacy Kendalyn Ferner added, “Copay accumulators can shift costs and jeopardize access to care for Floridians living with MS. The National MS Society supports policies that allow copay assistance to count towards a person’s deductible.”