Senator Tom Wright (R-New Smyrna Beach) and Representative Lindsay Cross (D-St. Petersburg) today filed SB 46 and HB 1063 for the 2023 Legislative Session.
Copay Accumulator is the name given to a scheme where Pharmacy Benefit Managers (PBMs) and insurance companies accept copay assistance payments made on behalf of patients but do not apply such copay assistance payments to the patient’s deductible, out-of-pocket maximum, or co-payment responsibility. This bill requires that all money paid to PBMs and insurance companies for prescription drugs must be applied to the patient’s deductible, out-of-pocket maximum, and co-payment responsibility regardless of who paid the money.
“Regardless of where it comes from, money accepted by PBMs and insurance companies for prescription drugs should count toward the patient’s deductible and out-of-pocket maximum. PBMs and insurance companies should not be allowed to double-dip at the expense of patients who are struggling with chronic illness.” said Senator Tom Wright.
“I’m incredibly proud to be sponsoring this legislation because Floridians deserve financial relief for costly prescriptions. Our current system costs patients more to get the life-saving medications they need – that just isn’t right,” said Representative Lindsay Cross.
“Unfortunately, insurers have been allowed to manipulate copay accumulator policies, forcing patients to pay more. That’s because copay assistance– which is often offered by third parties and drug manufacturers to lessen the cost of medication for the patient – isn’t counted toward the patient’s annual deductible. This broken system often requires patients to pay expenses out of their own pocket even though the insurer has already received payment from another source,” said Donna Sabatino, RN, ACRN, The AIDS Institute, Tampa, Florida.
“Persons with bleeding disorders rely on specialty medications to prevent or treat painful and dangerous bleeding. No generics or low-cost alternatives exist. Copay assistance isn’t causing them to purchase higher-cost drugs; it’s giving them a lifeline to the only options they have to prevent severe joint damage or death. Florida health plans should never be allowed to pocket that copay assistance for themselves and threaten patients’ health,” said Mark Hobraczk, JD, MPA, Senior Manager for Policy, Hemophilia Federation of America.
“Copay accumulators can shift costs and jeopardize access to care for Floridians living with MS. The National MS Society supports policies that allow copay assistance to count towards a person’s deductible,” said Samantha Strickland, Senior Manager of Advocacy National Multiple Sclerosis Society.
