Committee hears bill to count co‑pay assistance toward patients’ deductibles

Representative Furtado introduced House Bill 6209 to require that payments made on a patient's behalf—whether by manufacturers, nonprofits or other third parties—be counted toward a patient's deductible or maximum out‑of‑pocket if no generic alternative exists or after required prior authorization/step therapy.

Paul Adam, a volunteer with the American Cancer Society Cancer Action Network, described personal financial harm from accumulator adjustment programs and said he pays a $2,400 co‑pay once a month for a specialty injection; after his insurer stopped applying co‑pay assistance to his deductible, he accrued medical debt and missed medication for six months. "Each day without my shots causes me debilitating pain," Adam told the committee.

Ryan Strick of ACS CAN explained language changes meant to limit brand‑drug incentives: the bill would count assistance only when there is no generic alternative or after the patient has satisfied utilization requirements; it would also preserve eligibility for health savings accounts. Bill Murphy of the Epilepsy Foundation of New England echoed support, citing studies showing co‑pay assistance lowers patients' out‑of‑pocket costs and that accumulator policies can push patients to forgo treatment.

Sean Donahue of Blue Cross Blue Shield of Rhode Island opposed the bill, arguing co‑pay foundations are often manufacturer‑funded and that counting those payments toward deductibles could incentivize brand‑drug use and raise premiums. He cited regulatory and enforcement actions in other jurisdictions and warned the policy could disrupt insurance contract design and premium tradeoffs for consumers.

Committee members probed whether foundations or family‑paid assistance would be covered and asked insurers and advocates to continue negotiating specific language. The hearing concluded without committee votes.