Counting Copay Assistance Helps Rein in Out-Of-Pocket Expenses for Vulnerable Patients

By Consumers For Quality Care, on July 14, 2021

While many Americans struggle to afford out-of-pocket health care costs, insurance companies and pharmacy benefits managers are continuing to pull the rug out from under consumers who need help affording their prescription drugs.

According to Kollet Koulianos and Keri Norris, both executives with the National Hemophilia Foundation (NHF), one simple solution to cutting prescription drug prices is to require all commercial health plans and pharmacy benefit managers to count the value of copay assistance toward a patient’s cost-sharing requirements.

“If Washington is serious about making medicines more affordable and stopping health plans from engaging in deceptive practices that hurt and confuse patients, the Biden administration and Congress should require all commercial health plans and PBMs to count the value of copay assistance toward a patient’s cost-sharing requirements,” Koulianos and Norris wrote.

A national survey from NHF found that 65 percent of patients and caregivers reported using or having used copay assistance to afford their medications. One in three respondents who said they were unable to afford their prescriptions because copay assistance ran out was a person of color.

Millions of Americans, particularly those with chronic conditions, rely on copay assistance to afford costly prescription drugs. CQC urges lawmakers to prioritize health equity by making it easier for vulnerable patients to afford the medications they need.