Senate bill on copay assistance: sponsors push transparency and require assistance count toward deductibles

Senate Bill 773 was presented to the committee as legislation to ensure that patient assistance — including copay assistance from manufacturers or charitable sources — counts toward plan deductibles and out-of-pocket maximums.

Sen. Steve Hershey, the bill's sponsor, described the measure as the result of a multi-year compromise intended to guarantee that when patients receive assistance to meet copays or deductible obligations the assistance reduces their cost-sharing obligations rather than being treated only as a third-party payment that leaves the patient exposed. Advocates said the measure includes industry-standard notification language and common definitions of carriers and high-deductible plans.

Lance Kilpatrick of the American Cancer Society Cancer Action Network testified in support and framed the issue around patients with cancer, HIV, MS and other chronic or rare diseases who rely on assistance to access high-cost specialty drugs. He noted that 21 states, Washington, D.C., and Puerto Rico have similar bans on copay accumulators and that analyses have not shown meaningful premium impacts; the bill as amended would provide upfront notice about the duration and amount of assistance and thus give patients information to make choices.

Vice Chair Collison and other members asked technical questions about how assistance is applied at point of sale and whether assistance that reduces a payer's charge would also effectively lower the payer's portion of the bill. Sponsors said the bill is designed to provide transparency and to ensure patients receive the actual benefit of assistance programs when they need them.

The committee concluded the hearing without a recorded vote; sponsors said they planned further negotiations to finalize technical points but sought a favorable outcome.