The copay accumulator program hurts patient access to treatment. The program, created by insurance companies who deemed copay assistance cards given to patients by manufacturers as a gift or grant, basically created a loophole that lets insurance companies use the copay assistance card to help pay for their portion of a medication. “This means that the patient is being asked to pay more,” Dr. Alexander said.
The ACR is actively advocating for two bills currently before Congress that address these two issues:
- The Resident Physician Shortage Reduction Act (H.R. 2256/S. 834) would increase training spots by 14,000 over the next seven years, with a specific mandate requiring that at least 50% of the additional spots added yearly would be directed to specialty programs like rheumatology;
- The Help Ensure Lower Patient (HELP) Copays Act (H.R. 5801) would mandate that insurers count the value of copay assistance toward the cost-sharing requirements of a patient’s plan.
The day after the ALC, attendees took part in a mix of in-person and virtual meetings with their members of Congress to share their stories and advocate for the two bills with the hope to gain a broader coalition of bipartisan support.
Attendees Laud Program
Chad Hille, MD, a rheumatology fellow at Ochsner Health, La., who attended this year’s program came away with a new sense of the importance of both advocacy and participation in it. “This was my first time going to an advocacy conference like this,” he said, noting that it was particularly great at providing a primer on how advocacy works. “All in all, I thought this was a very rewarding experience, and I am definitely planning on doing more in the future.”
Attendee Julie Campbell, MD, a pediatric rheumatology fellow at Seattle Children’s Hospital, commented on how much she learned about issues such as the copay accumulator program. “The names of these programs are often very vague and seem beneficial, but they offer no benefit to the patient whatsoever,” she said. “I suspect many other rheumatologists are unaware of this as I was—and certainly many patients must be.”
Going forward, she hopes to use what she learned by staying involved with the ACR’s advocacy efforts. “Personally, I will also make sure [to tell] any patient I suggest [look into] a prescription drug coupon program to check with their insurance first to see if they have a copay accumulator program that might lead to a large surprise bill,” she said.