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Health industry groups oppose S.B. 207, caution that copier‑coupon mandates could raise premiums
Summary
Witnesses from AHIP, the Ohio Association of Health Plans and PCMA told the committee that a statutory requirement to count manufacturer copay coupons toward patient cost sharing would reward manufacturer marketing, undermine insurer benefit design, and risk raising premiums for all enrollees.
Keith Lake, regional director for AHIP, and Megan Richwine, director of government affairs for the Ohio Association of Health Plans, told the Financial Institutions, Insurance and Technology Committee they oppose Senate Bill 207, which would require health plans to apply amounts paid through manufacturer copay coupons toward insureds’ cost‑sharing requirements.
"Co pay coupons are essentially a bait and switch game," Keith Lake testified, arguing manufacturers use coupons to steer patients to higher‑cost brand drugs and mask true prices. He said accumulator programs are a tool insurers use to protect plan design and discourage market distortion.
Megan Richwine said copay coupons are marketing tools that increase premiums and noted that Medicare and Medicaid prohibit such coupons as illegal kickbacks. "If we really want to decrease prescription drug costs we ought to ban copay coupons, not promote them through policies like Senate Bill 207," she said.
Committee members pressed witnesses on distinctions among coupons, manufacturer patient assistance programs, and direct payments to insurers (which the speakers said generally count toward cost sharing). Witnesses described typical mechanics: manufacturer coupons reimburse the pharmacy directly and do not pass through the insurer, which is why accumulators can prevent coupon value from counting toward a patient's deductible or out‑of‑pocket maximum.
PBM and industry witnesses cautioned that the bill's sweep could create costs for employers and small fully insured groups while self‑funded ERISA‑regulated plans would be unaffected. The Pharmaceutical Care Management Association submitted opponent testimony warning that coupons have been associated with higher list prices and commercial spending and urged policymakers to preserve means‑tested patient assistance while avoiding statutory mandates that require plans to accept coupons.
The committee recorded extensive oral testimony and Q&A but no final vote on S.B. 207 in the provided transcript.
