If passed, the bills — introduced by state Rep. Mia Ackerman (D-Cumberland) and the late state Sen. Maryellen Goodwin (D-Providence) — would eliminate copay accumulator adjustment programs, which prevent pharmaceutical company coupons from counting toward patients’ deductibles.
“Insurance companies don’t like” the coupons, wrote Michael Barton Laws, associate professor of health services, policy and practice, in an email to The Herald. “The main reason for copays is to discourage utilization” — so insurers do not count manufacturer coupons toward patient deductibles, he explained.
As a result, enrollees on high-deductible plans have to pay more money before their insurance fully covers their health care costs, increasing their overall health care expenses, said Ryan Strik, Rhode Island government relations director of the American Cancer Society Cancer Action Network.
The current CAA contribution policy is “a real problem for patients, particularly cancer patients,” who face high costs for prescription drugs, treatments and therapy, Strik said. “Too often, we’re seeing folks … turning toward delaying their treatment or cutting their pills or foregoing treatment altogether because they can’t afford it.”
“Families battling cancer have enough to deal with,” Ackerman said in a press release. “They should not also be overwhelmed by medical bills. This legislation would help relieve some financial pressure so patients can focus on their recovery.”
According to Strik, the ACS has been heavily involved in proposing, drafting and introducing the bill, in addition to advocating for it at the local and state level.
Strik testified in front of the state House Corporations Committee on April 5 and said that committee members received the bill positively. The committee recommended the bill be held for further study, The Herald previously reported.
But the bill has also prompted some concern: Manufacturer coupons, Laws wrote, encourage patients to buy more expensive products when they otherwise would not “either because there is a cheaper generic alternative, or they just can’t afford it.”
Insurance companies have also come out against the bill: America’s Health Insurance Plans, an advocacy group representing thousands of insurance companies nationally, submitted testimony to the committee stating that the bill “does nothing to address the rising cost of prescription drugs. Rather, it endorses drug manufacturers’ egregious pricing behavior.”
Rich Salit, public relations manager at Blue Cross Blue Shield Rhode Island, wrote in an email to The Herald that large pharmaceutical corporations have expressed their support for similar bills across the country.
That support “is disguised as an effort to advocate for patients when, in reality, it’s a veiled attempt to drive up sales of (Big Pharma’s) costly brand-name medications,” Salit wrote. “The pharmaceutical companies seek to disincentivize the use of therapeutically equivalent generics and shift the cost (to) their high-priced, highly advertised drugs.”
“The R.I. bill bans all CAA models, regardless of whether there is a generic alternative,” Laws wrote. The bill also bars “counting other sources of help consumers may get (to reduce out-of-pocket costs), such as charitable assistance,” he added.
Paul Adam, Rhode Island vice-state lead ambassador for ACS, wrote in an email to The Herald that coupon programs personally helped him afford the available high-cost medication for his psoriatic arthritis, as there are no lower-cost alternatives. Adam added that if a lower-cost drug was available, his insurance would require him to take it.
In cases where generic alternatives aren’t available, individuals “are left to face the high costs and premiums put forward by their insurance providers to access the drugs they need,” Strik wrote. “These assistance programs are critical for individuals like Paul.”
Salit wrote that an anticipated increase for brand-name drugs will “drive up insurance premiums and increase health care costs for all” if the bill is passed.
The ACS faced similar criticisms in previous work — including increasing access to biomarker testing in the state and expanding coverage for colorectal cancer screening. But according to Strik, insurance companies did not significantly raise premiums as critics had suggested.
Laws added that the bill “doesn’t seem likely to have much, if any, impact on premiums, since it’s only going to apply to a relatively small number of people who have high-deductible plans and expensive prescriptions for which (CAA) coupons are available.” He added that the bill would cost insurance companies “at most $8,000 to $10,000 per year and may save them money if people decide not to take (the higher-cost) medications.”
A study conducted by the Commonwealth of Massachusetts Health Policy Commission found that coupon programs increase unnecessary health care expenditures “with implications for higher premiums.” They also found that these programs help patients who cannot afford necessary prescriptions. According to the study, “in these cases, coupons provide financial relief and likely improve adherence, leading to better clinical outcomes.”
According to Laws, while this bill aims to make health care more accessible, it is only a small solution and not enough to address the larger issue of a “Rube Goldberg contraption of a non-system of medicine in the U.S.”