Guest opinion: State and federal lawmakers need to put an end to copay accumulator programs
I grew up in Alabama, went to school in Alabama and founded Hometown Lenders, which is now the largest independent mortgage lender in Alabama, because I love and remain committed to fostering the community and hospitality that is innate to the people of this great state.
I am proud that my values are shared by my employees who have committed themselves to giving back to our community and helping those who are in need. Over the past 10 years we’ve have donated over two million dollars to organizations that are tackling some of America’s most significant healthcare challenges. From giving a million dollars to St. Jude’s Children’s Hospital to contributing $400,000 to renovate the pediatric floor of Huntsville Women’s and Children’s Hospital, we are committed to improving the lives of children and families.
But the funds only go so far and there are thousands of families in Alabama who need financial help to afford medical treatments. We need government to start finding solutions to addressing the rising cost of healthcare in this country. One place to start? Following the lead of 16 states nationwide including Arkansas, Louisiana, Tennessee, and North Carolina and pass a ban on the most recent obstacle to prescription affordability: copay accumulators.
What is a copay accumulator? It’s a newer language in most health care plans here in Alabama inserted by insurers and pharmacy benefit managers (PBMs) to try and encourage people to use generic drugs vs newer specialty medications by not counting financial assistance towards copays or deductibles. The theory being that if people have two treatment options, they will choose whichever costs less. The problem is that 79% of the medications covered in the program have no generic option, so the actual result is that it makes more modern, and potentially more effective life-saving medicines/ treatments unaffordable—leaving patients in a lurch.
There are thousands of examples of illnesses/ drugs impacted but let me tell you about one in our state:
UAB Medicine is an internationally renowned center recognized for their clinical care and research of cystic fibrosis (CF), a hereditary chronic illness that impacts tens of thousands of patients all over the U.S. What was once considered a fatal diagnosis, has seen incredible progress thanks to the discovery of CFTR modulators, which treat the root of the disease. But all CFTR modulator treatments, which were researched in part here at UAB, are subject to copay accumulators. Meaning that for many with CF who have been waiting years for this miracle are now being told they can’t receive help affording it and therefore it is out of reach.
My stepmother has battled common variable immune deficiency for years, so we know firsthand the obstacles that patients with chronic diseases face. I can’t imagine someone telling her she could live longer and more comfortably but for a well-intentioned but poorly executed plan that most people don’t even know is in the fine print of their healthcare policy.
The good news is that lawmakers here in Alabama and in Washington D.C. have taken notice of this issue, and I am hopeful that we will see legislation introduced to ban this practice. There is already a bill in Congress, just reintroduced a few weeks ago called the Help Ensure Lower Patient (HELP) Copays Act. Last session it had dozens of cosponsors from both sides of the aisle and I encourage members of the Alabama Congressional Delegation to hop on this bill as a co-sponsor this time around to help ensure passage.
Both state and federal lawmakers need to stand up against greedy insurance and PBM companies by putting an end to copay accumulator programs that put the health and wellbeing of our families, friends, and neighbors at risk.
Billy Taylor is Founder and Chief Executive Officer of Hometown Lenders in Huntsville, Alabama