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Kaine & Marshall Introduce Bipartisan Bill to Protect Patients from High Drug Costs

WASHINGTON, D.C. – U.S. Senators Tim Kaine and Roger Marshall, M.D. (R-KS), members of the Senate Health, Education, Labor, and Pensions (HELP) Committee, introduced the bipartisan Help Ensure Lower Patient (HELP) Copays Act, legislation that would protect patients from harmful insurance and Pharmacy Benefit Manager (PBM) practices that raise out-of-pocket drug costs for patients.

“Thousands of patients depend on copay assistance programs to afford the lifesaving medications they need,” said Kaine. “Health insurers and pharmacy benefit managers shouldn’t be able to double dip on profits while preventing patients from accessing their medications. The HELP Copays Act would protect patients from these harmful practices, lower drug costs, and help ensure patients can access the medications they need.”

Many patients, particularly those with chronic illnesses, rely on specialty medications that can cost tens of thousands of dollars — even with insurance. These patients often turn to copay assistance programs, in which a non-profit organization or a drug manufacturer covers the cost not paid for by insurance, instead of the patient paying a high out-of-pocket cost. In order to keep their profits high, health insurers and PBMs developed copay accumulators, which prevent the value of the copay assistance from counting towards a patient’s deductible or out-of-pocket maximum. When the value of the copay assistance runs out, a patient will discover they still owe their full deductible, this allows insurers and PBMs to earn a profit from both a patient’s copay assistance and from payment of their deductible. It also makes it harder for patients to afford their medications once their copay assistance runs out because they still have to meet their deductible or out-of-pocket maximum.

The HELP Copays Act would prohibit the use of “copay accumulators” and require health plans and PBMs to count the value of copay assistance towards a patient’s deductible or out-of-pocket maximum. Virginia is one of 19 states that have banned copay accumulator programs, and this bill would build on Virginia’s progress.

The HELP Copays Act is cosponsored by Senators Cory Booker (D-NJ), Ted Budd (R-NC), Shelley Moore Capito (R-WV), Chris Coons (D-DE), Joni Ernst (R-IA), Kirsten Gillibrand (D-NY), Ed Markey (D-MA), Lisa Murkowski (R-AK), Markwayne Mullin (R-OK), Mark Rounds (R-SD), Thom Tillis (R-NC), Elizabeth Warren (D-MA), and Chis Van Hollen (D-MD). Companion legislation was introduced in the U.S. House of Representatives by Representatives Earl L. “Buddy” Carter (R-GA-1), Nanette Barragán (D-CA-44), Mariannette Miller-Meeks (R-IA-1), and Diana DeGette (D-CO-1).

Full text of the bill is available here.