Two of the Nation’s Largest Patient and Provider Advocacy Coalitions Join Forces to Call for Inclusion of Consumer-Friendly Policies in PBM Reform Legislation
All Copays Count and the Safe Step Act Ad Hoc Coalitions represent more than 200 individual organizations.
Together, the Safe Step Act Ad Hoc and All Copays Count coalitions are made up of over 200 patient and provider organizations seeking to improve access and affordability for medically necessary treatments. Many member organizations represent and care for populations that rely on prescription drugs to keep disease at bay, enabling their communities to support their families and lead productive lives.
The Safe Step Act and HELP Copays Act are patient centered reforms that address the most common and devastating barriers to treatment adherence. These bills have been vetted at the state level, and they enjoy broad, bipartisan support in Congress.
- HR 2630/S 652, the Safe Step Act, would ensure that employer health plans offer a medically reasonable and expedient step therapy exceptions process. Step therapy occurs when a patient’s insurer or PBM refuses to cover the cost of a medication until the patient tries and fails on other treatments selected by the PBM. Without reform, step therapy-related delays in care lead to severe or even irreversible health outcomes.
- HR 830, the HELP Copays Act, would ensure that copay assistance is counted towards a patient’s deductible and out of pocket maximum. Without reform, patients struggle to afford their treatment and frequently take less than prescribed or go without.
“In recent years, PBMs have found yet another way to pad their bottom line at the expense of patients,” said Stephanie Hengst, Manager for Policy & Research at The AIDS Institute. “Copay accumulator programs allow the use of third-party copay assistance programs for patients but refuse to apply that dollar amount to the patient’s out of pocket maximum obligation or deductible. This is just the sort of issue the Senate HELP committee is working hard to address and will serve to help patients afford their medications if included.”
“This is a great opportunity for [industry-leading] employers to respond to and support their employees’ needs and overall well-being while increasing workforce productivity and reducing overall health care costs,” said Anna Hyde, VP of Advocacy & Access at the Arthritis Foundation. “When an employee’s disease worsens due to failed prescription drugs, employers are forced to spend more on their coverage. That means they have less flexibility to focus on other initiatives to protect their staff. Employers want their team members to have access to high quality comprehensive health care. Eliminating cost and time insurance protocols that do not always adhere to clinical guidelines within the insurance plans they offer is a great way to support our employees."
Any PBM reform must incorporate patient centered policies, including the Safe Step Act and the HELP Copays Act. Chairman Bernie Sanders (D-VT), Ranking Member Bill Cassidy (R-LA), and members of the Senate HELP Committee can act by co-sponsoring these bills and supporting their inclusion in the legislative package scheduled for markup on May 2.
Read the Steering Committee Letter.
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