The Honorable Earl L. “Buddy” Carter
U.S. House of Representatives
2432 Rayburn House Office Building
Washington, DC 20515
RE: Thank You for Your Leadership to Ensure All Copays Count for Patients
Dear Representative Carter,
On behalf of Georgia patients and their families, nurses, and physicians, we commend you for your leadership on issues that improve health care access and affordability for Georgia communities. Amid the health and economic challenges that our neighbors are facing every day, it is imperative to find solutions that help Georgians afford the treatments and services they need to manage their health.
We thank you for your leadership to reintroduce the Help Ensure Lower Patient (HELP) Copays Act in the 118th Congress to address deceptive health insurance and pharmacy benefit manager (PBM) practices that impact copay assistance for patients.
On behalf of the patients we serve at ARxC/Rx in Reach GA Coalition, we commend you for working across the aisle on this important bipartisan initiative to ensure health plans and PBMs count the value of copay assistance towards patient out-of-pocket cost requirements. We stand ready to work alongside you in this effort to protect the health and well-being of Georgians and all Americans.
Many patients rely on copay assistance programs to access and adhere to their prescription medications. This is especially true for patients who use copay assistance for medications for which there are no generic equivalents. In fact, the vast majority (79%) of brand medications with available copay assistance do not have a generic equivalent.i But more frequently, health plans and PBMs are instituting harmful “copay accumulator” policies that prevent copay assistance from counting toward a patient’s annual deductible or maximum out-of-pocket cost requirement. Copay accumulator policies put patients in dire health and financial situations by requiring them to pay the same amount twice to get closer to their out-of-pocket cost maximum. To increase their profits, health insurers and PBMs are essentially double dipping into copay assistance meant for patients in need. This can have alarming consequences, as research shows a majority of patients (69%) abandon treatment at the pharmacy when out-of-pocket costs exceed $250.ii
As advocates for diverse Georgia patient communities and the providers who care for them, we fully support the HELP Copays Act and federal efforts to ensure copay assistance counts towards patient cost-sharing requirements. The legislation builds on the efforts of 16 states – including Georgia – and Puerto Rico that have already passed policies to ensure copay assistance counts towards patient out-of-pocket cost responsibilities. Absent congressional action, health plans and PBMs will continue to take advantage of the most vulnerable populations in our healthcare system who rely on medically necessary medications to stay alive and well.
Our groups stand ready and eager to work alongside you to champion this bipartisan policy and build support for legislation that will make a meaningful difference to help patients access and afford their medications.
Thank you for your leadership for Georgians and for patient communities across the country.
Rx in Reach Georgia Coalition, stands ready and eager to work alongside you to champion this bipartisan policy and build support for legislation that will make a meaningful difference to help patients access and afford their medications.
Thank you for your leadership for Georgians and for patient communities across the country.
i USC Leonard D. Schaeffer Center for Health Policy & Economics. “A Perspective on Prescription Drug Copayment Coupons.” February 2018.
ii IQVIA. “Patient Affordability Part Two: Implications for Patient Behaviors & Therapy Consumption.” May 2018.
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