STATEMENT FROM NCODA LEGISLATIVE & POLICY ADVISORY COMMITTEE (LPAC)
www.ncoda.org
February 16, 2023
On February 9, 2023, US Representatives Earl L. “Buddy” Carter (R-GA), Nanette Barragan (D-CA), Mariannette Miller-Meeks (R-IA), and Diana DeGette (D-CO) introduced the Help Ensure Lower Patient (HELP) Copays Act to the House floor. This bill aims to prohibit pharmacy benefit managers (PBMs) from utilizing “copay accumulator” schemes.
This bipartisan bill would require PBMs to count cost-sharing assistance towards a patient’s deductible or out-of-pocket maximum. This means that patients are less likely to be required to spend more than anticipated on prescription medication, and PBMs will not be able to pocket any money from copay assistance. As a result, the financial burden due to high medication costs on patients and their families will be alleviated.
This bill falls in line with sixteen other states and Puerto Rico, who have been actively working towards ensuring that copay assistance counts towards patients’ out-of-pocket costs. With the introduction of this bill on the House floor, more states can take notice of this issue and look to address it.
NCODA has been outspoken regarding PBMs and the effect that they have on patient access to care. We believe that revamping the PBM system is a priority to ensure that all patients are able to receive access to quality and affordable treatment. We applaud Representative Carter and every representative who has taken this step to bring awareness to this issue. NCODA, along with the Patient Access Network (PAN) Foundation co – authored a letter in support of this bill late last year. The bill had to be re-introduced due to the death of the bills former sponsor. Read press release HERE.
NCODA will continue our Mission to support patients and practices. Our organization and staff will remain firmly focused on this issue, and as we will continue our analysis of this and other important decisions as more information becomes available. To learn more about active laws and/or enacted legislation regarding copay accumulators, view NCODA’s Oncology Legislation Tracker here: www.ncoda.org/oncology-legislation-tracker.
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About NCODA
NCODA is a leading nonprofit organization dedicated to empowering medically integrated oncology practices to deliver positive, patient-centered outcomes by providing leadership, expertise, quality standards, and best practices. For more information about NCODA visit www.ncoda.org or follow @NCODA on LinkedIn.