CHB Action Alert for Copay Accumulator

April 17, 2024 Jennifer DeGlopper

Dear Coalition for Hemophilia B Member:

Access to treatment for Factor IX patients is a paramount issue for The Coalition for Hemophilia B. Whether it is through nonprofit organizations like AccessiaHealth or the PAN Foundation or through a manufacturer copayment card, copayment assistance helps with expensive medical treatments by assisting in satisfying the deductible and the out-of-pocket maximum. Since the patient protections passed the Affordable Care Act, health insurance providers have developed policies to transfer costs back to the patient and limit their financial risk.

Copayment Accumulators are one such practice. Health insurance providers have instituted a policy where they refuse to count the copay assistance towards the out-of-pocket maximum or the deductible. By refusing to count the assistance to the out-of-pocket maximum the insurance company is passing more of the cost onto patients.

There is state and federal legislation introduced to end this practice. In Congress, H.R. 830, and its Senate companion, S. 1375, The HELP Copays Act will end this practice and ensure that all copayment assistance will count toward deductibles and out of pocket maximums. We are asking for our membership to become involved and contact their Member of Congress and United States Senators and ask them to cosponsor H.R. 830/S. 13.75, The Help Copays Act.The Following

To look up who your Member of Congress is please go to the website www.house.gov,
To determine your United States Senators, please go to www.senate.gov
Please modify the below email/letter,
Please contact CHB and we will provide you with the Legislative Assistants to email your letters. Email Kim Phelan at kimp@hemob.org
Email letters.

Thank you so much for your advocacy. As a community we must work together to shine a light on the practices of health insurance providers and assist Factor IX patients in having a voice in public policy. If you have any questions, please contact me directly at kimp@hemob.org

Sincerely,

Kim Phelan

COO

Draft House of Representatives Letter

Dear (Insert Name):

Thank you for your leadership in Congress. I am (insert names), a constituent from (insert city/state). (Please insert information about your life/situation). I am writing to ask you to cosponsor H.R. 830, The HELP Copays Act.

The HELP Copays Act (HR 830) wouldend the practice known as the copay accumulator for ERISA and other insurance plans. This practice allows health insurance providers to accept assistance but not count the amount toward the out-of-pocket maximum. The legislation would require health insurance plans to accept and apply any patient assistance payments made on behalf of the patient toward the deductible or out-of-pocket maximums.

(Please add any information if you were affected by the copayment accumulator issue)

Thebill was introduced by Congressman Buddy Carter (R-GA) and Congresswoman Nanette Barrigan (D-CA) and currently has 126 cosponsors. This legislation would help Americans who are affected with rare and chronic conditions by ensuring access to expensive and complex specialty medications. Your leadership is needed to advance this important issue for bleeding disorder patients.

Please cosponsor this important legislation. Your constituents will welcome your leadership on this issue. If you have any questions, please contact me directly ________________. Thank you for your consideration.

Sincerely,

Names

Address

Phone

Draft Senate Letter

Dear (Insert Name):

The HELP Copays Act (S. 1375) would end the practice known as the copay accumulator for ERISA and other insurance plans. This practice allows health insurance providers to accept assistance but not count the amount toward the out-of-pocket maximum. The legislation would require health insurance plans to accept and apply any patient assistance payments made on behalf of the patient toward the deductible or out-of-pocket maximums.

(Please add any information if you were affected by the copayment accumulator issue)

The bill was introduced by Senator Roger Marshall (R-KS) and Senator Tim Kaine (D-VA) and currently has 17 cosponsors. This legislation would help Americans who are affected with rare and chronic conditions by ensuring access to expensive and complex specialty medications. Your leadership is needed to advance this important issue for bleeding disorder patients.

Sincerely,

Names

Address

Phone