Register for free to manage your followed authors and newsletters in one place.
Sign in to load the authors you follow. ' +
'Sign in
You are not following any authors yet. ' +
'Use the follow buttons on stories or staff pages to build your list.
If you ask New Jersey state Sen. Jon Bramnick which industry exerts the most influence in Trenton, the answer is a no-brainer: health insurers.
So Mr. Bramnick felt like he notched a big win when then-Gov. Phil Murphy in January signed his bill prohibiting “copay accumulator” programs, a policy in which insurers do not count drugmaker-provided coupons toward a patient’s annual deductible and out-of-pocket maximum.
With the new law, New Jersey joined roughly half the country in restricting use of accumulators, an issue that doesn’t dominate headlines but is a major fault line in the battle between drugmakers, who say insurers are hoarding copay dollars, and health plans who say costs are high because drugmakers refuse to lower them.
The regulatory, legal and legislative history behind the accumulator debate is a mess, but the contours of the debate are straightforward.
Patients with cancer, HIV, cystic fibrosis or conditions with high-cost medications often use coupons from drug manufacturers to help them pay for the drugs. That assistance runs out, however, and patients learn the money was not counted toward their deductibles, the set amount of money a patient must pay for a drug or service before insurance kicks in.
“You still have to meet the deductible despite this discount program, which didn’t make any sense,” Mr. Bramnick said. “I think even the insurance companies sometimes have a hard time justifying it.”
Industry groups counter that accumulators are not only justified, but economically necessary because drugmaker coupons amount to a kickback for manufacturers.
“Copay accumulator programs are necessary because drug manufacturers’ copay coupons, which are illegal in Medicare and Medicaid, are a marketing tool used by Big Pharma to steer patients toward a more expensive drug instead of an equally effective, more affordable generic option, which leads patients and employers to pay higher drug costs,” said Greg Lopes, a spokesman for the Pharmaceutical Care Management Association, a major lobby for pharmacy benefit managers, or PBMs, which manage prescription drug benefits for insurers and employers.
Congress passed a series of health reforms in this year’s spending bill that were related to transparency and other topics. The lawmakers left the copay accumulator issue untouched, leaving a state-by-state jumble.
Twenty-six states, plus the District of Columbia and Puerto Rico, have moved to restrict the use of copay accumulators, either through new laws or by enforcing the ban through insurance regulation.
The laws vary in scope, ranging from outright bans to statutes that prohibit copay accumulators only when there is no cheaper generic alternative to a brand-name drug.
Several states are debating whether it is a good idea to restrict accumulators or side with industry groups who say drug companies’ coupons only exacerbate high costs.
Source: Read the original article on www.washingtontimes.com
