Nevada Bill Aims To Protect The Chronically Ill From This Insurer Practice

For many people suffering from chronic illnesses, the out-of-pocket costs for medication can be exorbitant. In a bid for relief, drug manufacturers sometimes supply coupons to cover costs until the patient’s insurance kicks in.

But those coupons don’t help like they used to.

Some insurance companies use a copay accumulator program, which denies the use of coupons toward a patient’s deductible and annual maximum out-of-pocket costs. That means it takes longer for patients to reach their deductible.

Nevada lawmakers have brought forward a bill that would require insurance companies to apply coupons toward the patient’s deductible, but only in cases of drugs without a generic alternative. Las Vegas resident Kelly Gonzalez uses coupons for medicine to treat bleeding disorders, but those coupons aren’t counted toward meeting her insurance deductible of $6,700 and maximum out of pocket of $13,000 for all coverage. And when considering her monthly premiums are $2,700 for the health plan, the proposal — Senate Bill 171 — would be a lifeline.

“It happens with hospitals, it happens with drugs … and that’s why I’m seeing all of these interested people out of the clear blue sky saying, ‘Oh that happened to me too or it’s happening to me too,” said Sen. Joe Hardy, R-Boulder City, who sponsored the bill along with Assemblywoman Melissa Hardy, R-Henderson.

Gonzalez last year opted to not seek hospital care for a “serious illness” because she was concerned that the out-of-pocket expenses would have been thousands of dollars.

“I couldn’t go to the hospital,” she said. “If I go to the hospital I don’t know what kind of tests they’re going to do. I don’t know what’s going to happen.”

But if the copay accumulator program proposal passes, she and other chronic-illness patients would more quickly meet the deductible and max out-of-pocket expenses on their insurance because the coupons issued by pharmaceutical manufacturers would count toward that target.

Copay accumulator programs were allowed under guidance from the federal Department of Health and Human Services in mid-2020. Jim Manley, a board member with health advocacy group Consumers for Quality Care, said a push for President Joe Biden to roll the programs back federally has begun, though nothing has been decided.

Without federal action, the burden falls to the state.

According to the Chronic Care Policy Alliance, Arizona, Georgia, Illinois, Virginia, West Virginia and Puerto Rico have restricted the programs in some way for state-regulated health care plans. The information the group published in December 2020 said lawmakers in 24 states were expected to tackle the issue in some form.

The bills’ first hearing drew opposition testimony from the Nevada Association of Health Plans and the Pharmaceutical Care Management Association. Bill Head, assistant vice president of state affairs with the association, testified that programs such as the copay coupons don’t exist for medical procedures because it would count as illegally inducing someone into a procedure.

He added that the coupons don’t generally exist for drugs without direct competitors.

“It may help an individual patient, and it’s hard not to be empathetic to that, but they will end up raising the cost for everybody under that particular health plan,” Head said.

Proponents of the plans argue they can push patients toward cheaper, generic alternatives to name-brand medications. This can be an issue, Manley stressed, as the medication for patients with some chronic diseases may not have any generic alternatives.

“The focus is on folks with chronic diseases, who have to use these so-called specialty drugs that could end up costing them a significant amount of money,” Manley said.

Stephanie Hrisca-Kennedy, a Las Vegas resident, has been outspoken against copay accumulator programs after managing treatment for her young son, who was diagnosed with Hemophilia A, a disease caused by a missing protein that would normally cause blood clotting.

The family initially believed his medicine would fall under a copay accumulator program, leading them to stressful discussions about how they would fund his treatment.

Turns out, their insurance company allowed the coupons to be used to pay down the deductible. Still, Hrisca-Kennedy has continued to speak out to advocate for other families who aren’t as fortunate.

“It’s hard for people like (my son),” she said. “They don’t have that option to turn to, they don’t have any generic brand of their medication.”

Hardy said the copay accumulator program means people with conditions like cancer or autoimmune disease get “blasted with more cost and less relief.”

“Theoretically, if you’re buying generic, you’re probably not paying as much, and if you’re buying a brand name, you’re paying more, so it becomes more meaningful for the people who are stuck paying for (situations) where there isn’t a generic,” Hardy said.

Senate Bill 171 survived the April 20 deadline with an exemption, though it has not passed either chamber of the Legislature. The measure passed through the Senate Committee on Commerce and Labor with a unanimous, bipartisan vote earlier in April. No immediate votes are scheduled.



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