Advocates press committee to ban copay accumulator programs and protect patients from surprise drug bills

Patient advocacy organizations, clinicians and patients urged the Joint Committee on Financial Services to advance legislation that would stop insurers from using copay accumulator and similar programs that prevent third‑party cost‑assistance from counting toward patients’ deductibles and out‑of‑pocket maximums.

Speakers from the Multiple Sclerosis care community, the Epilepsy Foundation of New England and patient advocates described families who rely on manufacturer assistance or foundation grants to afford specialty drugs and who then face surprise bills because insurers do not apply that assistance toward patients’ deductibles. ‘‘The insurance companies accept the financial assistance, do not apply it to the deductible or out of pocket, and then still bill the patient,’’ Marissa Shackleton of the Elliott Lewis Center said. ‘‘They’re getting paid twice.’’

Patient advocates described clinical harms when patients ration or abandon prescribed therapies because of cost. Kayla Cabo, who lives with ulcerative colitis, said she was told to take a biologic every day but instead rationed doses to afford it because of a cost‑sharing design that left her responsible for a full deductible despite manufacturer assistance.

Supporters noted that more than 20 states, plus Washington, D.C., and Puerto Rico, have enacted laws to require insurers to count third‑party financial assistance toward patients’ cost sharing. They urged Massachusetts to follow suit and to modernize consumer protections so assistance intended to reduce patient burden actually does so.

Representatives of patient foundations said they will submit written data on the number of requests for assistance and program spending. The committee did not vote at the hearing.