Commentary: Don’t let insurers just pocket prescription co-pay aid
Times Union Editorial Board
Marc Price, DO
Family physicians care for patients young and old throughout their lives. It is often our duty to tell a patient that he or she has a serious, sometimes life-threatening illness. In these circumstances, we try to comfort them and develop an effective treatment plan. We may recommend specialty care, surgery or other procedures and medications to afford the greatest chance at treating the illness or disease. Upon putting a treatment plan together, it is heartbreaking to see our patients unable to afford the recommended medications to help them fight or manage an illness or condition.
Co-pay assistance programs, offered by foundations, nonprofits, manufacturers of medications and others, are a lifeline to help patients cover their out-of-pocket costs for the medications they need.
Unfortunately, health plans and pharmacy benefit managers often refuse to allow patients to apply co-pay assistance credits to their deductible, in effect negating any patient benefit. Under this growing practice, health plans and pharmacy benefit managers receive the co-pay assistance payment but do not apply it toward the patient’s cost-sharing obligations, in essence double-dipping. This unfair practice is especially challenging for patients who have health insurance plans with high deductible or high co-payment requirements. Such plans have become common, especially with employers, because they contain premium costs.
The New York State Academy of Family Physicians has joined with over 70 other health provider and patient advocacy organizations in strongly supporting legislation to require health plans and pharmacy benefit managers to apply co-pay assistance benefits to the patient’s deductible. The bill, S5299A/A1741A, passed both houses of the Legislature nearly unanimously this year and now awaits action by Gov. Kathy Hochul.
In addition to the strong patient and provider support, the Black, Puerto Rican, Hispanic & Asian Legislative Caucus also supports this legislation. In a letter to the governor, the caucus said this legislation is particularly important for the most economically challenged patients, many of whom are also impacted by other health care disparities and inequalities that limit access to needed medications and other services.
We ask Hochul not to wait another day. We urge her to sign this bill into law to ensure that health plans and pharmacy benefit managers cannot pocket these funds, preventing patients from benefiting from co-pay assistance programs to help offset their out-of-pocket medication expenses.
Marc Price is a family physician in Malta and a past president and board member of the New York State Academy of Family Physicians.