Michigan House lawmakers are renewing the effort to ban co-pay accumulator programs. That’s language in some health plans that stops copay assistance payments from counting toward a patient’s deductible.
Supporters argue they lead to patients potentially having to spend thousands of extra dollars to get vital medication — for example, people with chronic diseases, like cancer, who require expensive medicines, would still need to spend more money than they otherwise would out of their own pockets to hit their annual maximums.
Representative Carrie Rheingans (D-Ann Arbor) said people can end up going without medication as a result.
“This is absolutely unacceptable in the richest country in the world, and no Michigander should ever have to go without their lifesaving medication because of the cost. By ensuring that all copays count, we’ll get one step closer to making this a thing of the past,” Rheingans said during a press conference Tuesday.
Accumulator programs are becoming more prevalent, said Sarah Procario. She's a leader with the Michigan All Copays Count Coalition and advocacy director for the Hemophilia Foundation of Michigan.
“When we formed our coalition in 2020, the Michigan marketplace had no plans with accumulator language on them. Unfortunately, that has changed, and now in 2023, 8 out of … 10 plans in Michigan do have a copay accumulator language on them,” Procario told reporters.
The industry group Michigan Association of Health Plans, however, said lawmakers should instead focus on prescription drug pricing. They place the blame on big pharmaceutical companies, who sometimes provide copay assistance through coupons or vouchers when their medicines become too expensive.
“Prohibiting health plans from instituting co-pay accumulator adjustment policies will only increase health care premiums and legitimize Big Pharma’s copay coupons, which are nothing more than kickback schemes to drive consumers to purchase their most expensive drugs,” Brian Mills, deputy director of commercial markets and communications at the health plan association, said in an emailed statement.
Rheingans dismissed those concerns about higher costs as not having come to fruition in the more than a dozen other states that have already implemented similar proposals as her bill.
A similar, Republican-sponsored, bill made it past the state House last legislative session but stalled in the Senate.
