Committee amends HB1216 to protect patients’ point-of-sale copay assistance, votes due pass

What happened: The House Industry, Business and Labor Committee approved a further-amended version of House Bill 1216 that, in its amended form, (1) prevents contributions from cost‑sharing assistance programs from being counted toward an enrollee’s deductible or maximum out‑of‑pocket, (2) allows copay assistance to be applied at the pharmacy counter to reduce the patient’s out‑of‑pocket cost at point of sale, and (3) requires the enrollee to notify the health benefit plan of any cost‑sharing assistance used to reduce copayments. The committee then voted to give the bill a due pass in committee.

Why it matters: Sponsors and patient advocates described cases in which patients receiving manufacturer or foundation assistance for high-cost specialty drugs were later billed by insurers that treated the third‑party assistance as the patient’s payment and clawed it back. The amendment is a compromise intended to preserve…