Important Issues

MSDC members Drs. Angus Worthing and Klint Peebles joined a panel of patient advocates and residents to ask the Committee on Health to pass B24-557, the Copay Accumulator Amendment Act. The legislation is strongly supported by MSDC as a way for patients who rely on specialty drugs to treat their conditions, and who may have high out-of-pocket costs or high deductibles they are required to meet.

The legislation was introduced last year by Councilmember Mary Cheh and four colleagues. The bill would require health insurers to apply discounts, financial assistance, payments, product vouchers and other reductions in out-of-pocket expenses made by or on behalf of a member when calculating the member’s coinsurance, copayment, cost-sharing responsibility, deductible, or out-of- pocket maximum for a covered benefit.

Dr. Worthing is a rheumatologist with a practice in DC and resides in DC. He testified as to how copay accumulators negatively impact his patients by delaying care. In his comments he noted:

Just how critical are these medications? The typical person with rheumatoid arthritis using copay assistance programs has already experienced disabling joint pain, fatigue, and other symptoms for about nine months before even getting diagnosed. Then they tried older, less-expensive first-line medications for several months. For the roughly half of people who were failed by these drugs, more expensive specialty drugs usually are effective and help them get back to work, school, and caring for family. It’s heartbreaking to see the look of fear and anxiety on my patients’ faces when they can’t afford the medications that rescued them from the pain they had for months or years until they started drugs that worked for them.

Dr. Peebles also focused on the negative impact copay accumulators have on his patients affording their medication. As a dermatologist, he noted, he sometimes needs to prescribe costly, long-term treatments for conditions that impact lifestyles and wellbeing of patients. Coupons for medications can make these prescriptions affordable, but copay accumulators backload costs and push patients to abandon these treatments when they see a large bill for their medication made larger by the fact that insurance companies count their savings against them.

Joining the physicians were representatives from the ALS Association, HIV + Hepatitis Policy Institute, the Arthritis Foundation, and the National Psoriasis Foundation. Those organizations testified to what they had seen in other states and what they themselves experienced when insurance companies refused to recognize coupons or count payment assistance programs against patients.

The next step for B24-557 is for a markup in the Committee on Health. MSDC will be watching closely but welcomes physicians to speak up and speak out on this important issue. For more information, contact our office.