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Bill would ban copay accumulators that keep patient assistance from counting toward deductibles
Summary
SB 11 99 would prevent insurers or pharmacy benefit managers from excluding manufacturer or third-party copay assistance from a patient's deductible or maximum out-of-pocket calculation; patient advocates described cases of large unexpected bills and lost coverage protections.
Sen. Weber Pearson presented SB 11 99 to prohibit copay accumulators and ensure that payments made by, or on behalf of, patients toward prescription cost sharing count toward the enrollee’s deductible and maximum out-of-pocket (MOOP). The Department of Insurance and numerous patient-advocacy organizations supported the bill, describing cases in which copay-assistance funds were not applied to patients’ out-of-pocket totals, leaving families with unexpectedly large bills.
Miguel Vasidas of the Department of Insurance described the bill as aligning state law with federal counting requirements and said the measure simply fixes an accounting issue so patients do not lose protections when manufacturers or charities help with cost sharing. Patient advocates recounted personal stories of weeks of administrative work and sudden demands for thousands of dollars when assistance funds were not counted.
Insurer and trade groups urged caution, noting parallel federal developments and arguing that codifying the federal standard in state statute could have broader market effects; they urged additional transparency and reporting requirements for manufacturers. Committee members thanked witnesses and the author for engaging with stakeholders and accepted committee amendments. The bill was moved to appropriations as amended and placed on call.
