Bipartisan legislation would count drug coupons toward deductibles, out-of-pocket maximums

February 08, 2023 3:19 PM | Anonymous

From Wisconsin Health News

Insurers and pharmacy benefit managers would have to count copayment assistance from drug companies toward patients’ annual deductibles and maximum out-of-pocket costs under a bill introduced by a bipartisan group of lawmakers Tuesday. 

In response, associations representing insurers and pharmacy benefit managers raised concerns about drug coupons, warning they increase overall drug costs.

Sen. Andrè Jacque, R-De Pere, said the “critical legislation” is about medication adherence and better health outcomes. He said that it can be “devastating” for patients to learn that they haven’t met their out-of-pocket commitments. 

“This is about making sure people can afford their medications and not have to choose between groceries and gas and being able to progress and deal with a chronic condition,” Jacque said at a press conference.  

A memo for the bill circulated to gain support for the plan from lawmakers noted that the legislation applies to prescriptions if there's not a "medically appropriate generic equivalent available," which the bill's sponsors argued removes concerns that the financial assistance would drive patients to higher-cost drugs.

Rob Gundermann, CEO of the Coalition of Wisconsin Aging and Health Groups, which is leading a group of around 40 patient and provider groups in support of the bill, said copay assistance programs were created by manufacturers to respond to efforts by health plans to shift the cost burden of prescriptions onto patients. 

“Copay assistance is a critical lifeline for patients across our state,” he said. 

Similar legislation introduced last session didn’t make it into law. It faced criticism from insurers and the Pharmaceutical Care Management Association.

“Drug companies offer coupons to insured patients, regardless of their incomes, to induce patients to take a more expensive brand drug instead of an equally effective, less expensive, alternative with lower cost sharing,” Sean Stephenson, director of state affairs for the association, which represents pharmacy benefit managers, said in a Tuesday statement. “Numerous analyses show an increase in the use of copay coupons correlates to a total increase in prescription drug spending.”

Wisconsin Association of Health Plans Executive Director John Nygren said some aspects of the proposal have changed since last session.

"Our fundamental concern remains the same: Copay coupons are marketing tools used by pharmaceutical companies to encourage use of their drug over alternative therapeutic options," Nygren said in a statement.

The Alliance of Health Insurers said in a statement that the legislation “would do nothing to control the soaring prices of prescription drugs.” 

“Perversely, this legislation would reward drugmakers for steering patients towards and keeping them on expensive brand-name drugs, costing all of us more money,” they said in a statement. “The federal government considers copay coupons an illegal kickback if used by an enrollee in Medicare or Medicaid because they induce a patient to use a specific drug. Copay coupons should be banned."

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