OpEd by Marcie Timmerman
Nearly two years ago, I was prescribed my first biologic medication to treat my autoimmune disease. Since then, this medication and others have been vital in managing my health. Innovative medicines, sadly, come with a steep price tag.
Fortunately, a co-pay assistance card was available from the drug manufacturer to help keep my out-of-pocket costs manageable and predictable.
Everything was going well for several months. I was feeling better on the biologic and the co-pay card was keeping my costs down. Then, a few months in, I got billed thousands of dollars for my monthly prescription. I panicked.
A call to the pharmacy and then to the assistance program revealed a “co-pay accumulator adjustment program” was the reason for this sudden increase.
It’s a practice that more and more insurance companies are implementing at the expense of patients like me. Payments made via my co-pay card are no longer counted toward my overall deductible and maximum out-of-pocket costs. This will end up costing me thousands of extra dollars just to adhere to the treatment plan laid out by my physician.
For autoimmune patients like me, medication is not optional or temporary. I will likely rely on these treatments for the rest of my life. Unless our legislators take action now to stop unfair insurance practices like the one that has prevented me from reaching my deductible, I may not be able to afford my prescriptions in the years to come.
That’s why Rep. Danny Bentley has introduced House Bill 72, which puts an end to co-pay accumulator adjustment programs and protects patients from being blindsided when they go to pick up their prescriptions. H.B. 72 requires health insurers to count all payments made by a patient or on their behalf toward their overall deductible and out-of-pocket maximum.
Patients shouldn’t be penalized by their insurance companies for using third-party financial assistance to afford their medications. Co-pay accumulator adjustment programs have only made it more difficult for Kentuckians to access the medications they need, which could compel them to skip dosages or forgo treatment altogether. We know that problems with medication adherence often lead to increased hospitalizations, poorer health outcomes and even higher health care costs. Real lives are at stake!
It is time for our legislators to put Kentucky patients first and ensure they can continue accessing the medications they need to be healthy and live comfortably. No one should have to choose between their health and their family’s financial security. House Bill 72 is an important step in the right direction.
Marcie Timmerman is an advocate, mother, wife, and resident of Lexington.