North Dakota hearing on HB 1216 spotlights patient hardship, insurer concerns over copay accumulator rules

Representative Karen Carls opened the House Industry, Business and Labor Committee hearing on House Bill 1216, saying the bill would bar insurers from using “accumulator” policies that keep manufacturer or other third‑party copay assistance from counting toward a patient’s deductible or out‑of‑pocket maximum.

The measure matters to patients who take extremely costly specialty drugs and who say insurer accumulator programs are producing large, unexpected pharmacy bills. Rep. Karen Carls, sponsor of HB 1216, described patients who rely on manufacturer and charitable assistance to afford drugs such as Trikafta and called the bill a way to ensure that assistance “is accessible to them.”

Why it matters: Supporters said accumulators can force patients to make impossible choices — skip needed medication or pay thousands up front — and that counting assistance toward cost‑sharing restores the intent of many manufacturer and nonprofit programs. Opponents said coupons and manufacturer assistance distort market incentives, drive higher drug prices and are difficult for plans to track, which could raise premiums for other enrollees.

Representative Karen Carls, sponsor Representative Karen Carls, sponsor of HB 1216, said many people taking high‑cost therapies face…