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Committee advances co‑pay accumulator ban after PERS warns of multimillion‑dollar biennial cost
Summary
Representative Carls presented a bill that would prohibit insurers from excluding third‑party patient assistance from out‑of‑pocket accumulators. PERS testified the change could raise state and political‑subdivision insurance costs in the biennium; the committee voted 4–1 to recommend the bill.
Representative Karen Carls presented House Bill 12-16, which would prohibit health plans from excluding third‑party assistance (manufacturer coupons or nonprofit help) from applying to a patient’s out‑of‑pocket maximum for covered prescription drugs.
Nut graf: The sponsor described the bill as targeted relief for patients with rare or high‑cost conditions who rely on manufacturer or nonprofit assistance to cover initial cost sharing. PERS told the committee the bill, as drafted, applies broadly to brand (tier‑2 and tier‑3) prescriptions in state and political‑subdivision plans and that Deloitte’s…
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