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Sponsors urge ban on copay‑accumulator programs, saying they leave patients with high costs
Summary
Senators Manchester and Liston urged support for Senate Bill 207, which would prohibit insurers and PBMs from using copay accumulator or maximizer practices that prevent third‑party assistance from counting toward patients' deductibles; sponsors said the bill preserves plan flexibility while protecting patients from surprise costs.
Senate Bill 207 drew sponsor testimony in its first hearing as Senator Manchester and co‑sponsor Senator Liston urged the committee to ban insurer and PBM practices that keep manufacturer or third‑party copay assistance from counting toward a consumer’s cost‑sharing obligations.
"This bill simply says that if a patient utilizes cost sharing assistance whether it is from a manufacturer program or another source, then that amount will be counted to meet any mandated cost sharing requirement of a health plan or PBM," Senator Manchester said. He framed the bill as not requiring additional coverage nor preventing plan sponsors from managing formularies, but as closing loopholes such as "maximizer" and "assisted funding" programs that sponsors said can steer patients into programs that leave them uninsured or with surprise bills.
Co‑sponsor Senator Liston illustrated the effect with a hypothetical: "Let's say I have a prescription drug that would cost $20,000 per year, and I have a $5,000 deductible... If I receive $1,500 in assistance, it wouldn't change the $5,000 I owe or make it so I can afford the needed medication. Instead, it decreases the $15,000 the insurer had contracted to pay." Both sponsors said 25 states have passed similar laws and that more than 60 patient and provider groups back the measure.
Sponsors acknowledged that insurers and PBMs opposed similar measures in prior sessions and said they crafted carveouts for medically appropriate generics and when prescribers deem brand drugs medically necessary to avoid steering patients to higher‑cost drugs. The committee concluded the first hearing with sponsor testimony and no immediate committee action recorded.
