Committee amends accumulator-bill; amendment removes grandfathered plans and drops fiscal impact

The committee took extended testimony on House Bill 1216, which would prohibit co-pay assistance from being excluded from a plan’s deductible or out-of-pocket maximum (commonly called “copay accumulator” or “coupon accumulator” rules). Patient advocates and the American Cancer Society and others urged the committee to require coupon amounts be credited toward patients’ cost-sharing obligations, arguing that otherwise patients with severe illnesses may be left with unaffordable bills.

Insurers and trade groups opposed the measure as originally written and testified on practical and market effects. Witnesses from Blue Cross Blue Shield and Sanford Health Plan explained they do not receive coupon-dollar transaction detail from pharmacies or PBMs and that the coupon process often appears “invisible” to carriers at the point of sale; carriers said they see the full drug charge submitted by pharmacies and do not receive a separate, machine-readable credit for a manufacturer coupon. Industry speakers also warned of unintended consequences and asked for careful drafting.

The committee adopted an amendment from Representative Carls (recorded in committee as Representative Carls/Carls’ amendment) that removed “grandfathered” plans from the bill’s coverage; Rebecca Fricke, Executive Director of the Public Employees Retirement System (PERS), told the committee Deloitte’s actuarial review of the amended bill showed no fiscal impact for PERS because the majority of PERS members are in grandfathered plans. Fricke said the original bill’s fiscal note had estimated roughly a 1.1% premium increase for PERS (about $9 million); with the amendment removing grandfathered plans the bill as amended had no fiscal impact for PERS.

Insurers and patient advocates continued to disagree on mechanics and effects: insurers said they could not track coupon payments in their systems and therefore carriers do not see coupon amounts applied at the point of sale; patient advocates argued coupons often act to steer patients to brand-name drugs with no generic alternative and leave patients exposed when carriers count only insured payments toward deductibles.

Why it matters: The bill addresses a contentious area of prescription-drug payment design—whether manufacturer coupons should reduce patient cost-sharing obligations. Carriers warned of technical difficulties and potential market distortions; patient groups said withholding coupon credit can leave patients with unaffordable out-of-pocket bills for specialty drugs.

What’s next: Following the adopted amendment (which removed grandfathered plans from application), PERS’ actuary reported no fiscal impact. The committee adopted a due-pass recommendation on the amended bill before leaving the item for future action or referral as appropriate.