In our community, I know many of us are concerned about the cost of health insurance and the availability of life-enhancing or life-saving drugs. This year alone, pharmaceutical companies have raised the wholesale and retail prices of 450 drugs. When it comes to drug availability, recent surveys have found doctors and physicians struggling with cumbersome prior authorization protocols that slow or restrict their ability to prescribe drugs to their patients.
Fortunately, two of my colleagues — Sen. Heather Sanborn (D-Portland) and Rep. Amy Roeder (D-Bangor) — have introduced bills to help protect Mainers from an unfair practice that some insurance companies use and to ensure that patients can obtain their prescription drugs.
Sanborn’s bill would protect Mainers from double billing. For those who don’t know, double billing occurs when a patient’s insurance company uses a “co-pay accumulator program” that – usually unknown to the patient – prevents manufacturer assistance coupons to co-pay to count for both the patient’s deductible and the maximum out-of-pocket expense. Unfortunately, the patient ends up paying more for the prescription drug, even though he needed financial assistance to pay for it in the first place. Patients can suffer financial hardship, especially when they need expensive drugs.
For example, a patient can take a pre-exposure prophylaxis (PreP) to prevent HIV named Descovy, which retails for $2,165.79. The drugmaker, Gilead, has a co-pay (voucher) assistance program that helps patients pay for their medications. However, if the patient’s insurance company uses a copayment accumulation program, the patient’s discounted copayment does not count toward the patient’s annual out-of-pocket maximums. Eventually, the patient will end up paying their entire deductible. Sanborn’s bill, LD 1783, would prevent double billing, which would protect Mainers from financial hardship and ruin when they need expensive prescription drugs.
My colleagues and I are working in other ways to ensure patients can access their prescription medications. Roeder’s bill, LD 1776, would allow pharmacists to dispense emergency supplies of medication to a patient when a prescription authorization is not available. As long as the pharmacist has a record of a previous prescription, he can dispense medication to the patient.
The bill would require insurance companies to cover emergency drug supplies. The bill would also give patients with chronic conditions, such as asthma, diabetes or heart disease, the peace of mind of being able to access their medications in an emergency.
On these issues, and more, my colleagues and I remain committed to helping Mainers live happy, healthy, and full lives. I know there is still a lot of work to be done to make health care affordable for everyone, but I also know that these two bills will ease the financial strain caused by high health care costs and uncertain access to medicines. on prescription.
If you have questions about healthcare and medications, please contact Consumers for Affordable Healthcare. Its consumer help line is 1-800-965-7476. If you ever need further assistance or would like to share your comments and thoughts with me, please contact me.
Anne Carney represents Senate District 29: Cape Elizabeth, South Portland and part of Scarborough. She can be reached at [email protected] or 207-287-1515.
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