ALBANY, N.Y. (WTEN) — New Yorkers battling chronic illnesses rely on copay assistance programs to afford their medication. However, some say these programs aren’t working. Lawmakers and advocates are supporting legislation that would fix this issue.
“The reality is what we’ve been doing with pharmacy benefits is we’ve been giving with one hand and taking away with the other,” said Assemblywoman Jo Ann Simon.
Under the current copay accumulator adjustment program, when a patient uses any form of 3rd party copay assistance – such as manufacturer coupons and patient advocacy groups – the payment doesn’t apply to their deductible.
Because of this, some patients can’t afford their medication and general cost of living. According to a survey from the National MS Society, up to 40% of people with MS have either altered or stopped taking their medication due to exorbitant costs.
Jennifer Muthig, a spokesperson with the National MS Society, is pushing for legislation that would allow 3rd party systems to go towards the patients’ annual deductible.
“We’ve had people who pay out of pocket — if you have a family plan it could be $16,000. So this would really allow folks like us to provide financial assistance whether you get a manufacturer coupon or a coupon from your doctor’s office,” said Muthig.
Pharmacist and Assemblyman John McDonald said that while New York has made progress with insurance companies, they’ve still got a way to go.
“At the end of the day we’ll continue to do our job in regards to managing that little battle going on between the manufacturers and the PBMs and the insurance companies, but we need to leave the patients alone. We need to make sure we reduce the barriers so they can have good quality outcomes,” he said.
The bill did pass in the Senate last year and has received bipartisan support in the Assembly this year. Advocates are hoping to finally see an end to copay surprises and provide immediate relief to New York patients.