(The Center Square) – Coupons or other help Ohio patients receive to pay for prescriptions could soon count toward copays and out-of-pocket expenses.
New bipartisan legislation in the state Senate would stop health insurance companies from using copay accumulator programs that don’t count the discounts and potentially increase out-of-pocket expenses when the help ends.
“Money is money, no matter who’s paying,” said Sen. Beth Liston, D-Dublin. “If someone gets help paying for their medication, that help should count toward what they owe, not disappear into the insurance company’s pocket.”
The legislation, which includes Rep. Susan Manchester, R-Waynesfield, as a cosponsor, looks to help patients who receive coupons or copay help from drug makers or nonprofits to help pay for medications.
The lawmakers say that often those with chronic and rare diseases tend to rely on coupons or help from drug companies or community organizations to help cover the rising costs of prescriptions.
Some health insurance companies, however, do not count the help toward a deductible or out-of-pocket maximums in health care plans. Lawmakers say when the help ends, patients are left with higher costs and limited coverage.
The new bill would:
• Stop insurers from designing drug benefits based on whether a patient is receiving financial assistance.
• Require insurers to count all payments toward out-of-pocket costs like deductibles and copays, whether they are from the patient or someone helping them.
• Protect patients from excessive charges by capping out-of-pocket costs at federal limits.
It’s the second piece of health care legislation pushed by Manchester.
In April, the Senate unanimously passed a bill that gives members of the Ohio Farm Bureau who want health insurance to enroll in the Farm Bureau Health Plan, which is exempt from regulation and not subject to Affordable Care Act guidelines.
Enrollees maintain consumer protections and options to seek recourse if necessary. The Farm Bureau is required to disclaim that the plan.
That bill, Senate Bill 100, is in the House Insurance Committee.
