Resolution 18-208

Submitted by: Richmond Academy of Medicine

WHEREAS,       the use of high cost specialty drugs is becoming more commonplace in everyday medical practice, and

WHEREAS,       a large portion of these costs are often applied to the patient’s deductible, copay, coinsurance or maximum out of pocket payments, and

WHEREAS,       more and more patients are subject to increasingly high-deductible insurance plans, and

WHEREAS,       many pharmaceutical manufacturers have provided patients with copay or coupon assistance programs to cover the patient’s portion of these expenses, and

WHEREAS,       many healthcare insurance companies have sought to shift the burden of these costs for high cost specialty drugs, back to the patient and the pharmaceutical manufacturer, and

WHEREAS,       many healthcare insurance companies have initiated Copay Accumulator Programs, within their insurance products, to avoid the benefit of the pharmaceutical manufacturer’s copay assistance program from covering the patient’s deductible, copay, coinsurance or maximum, out of pocket payments, and

WHEREAS,       many patients with chronic and rare diseases are vulnerable and depend on copayment assistance programs for their specialty medications. This new practice of copay accumulator adjustment, coupled with the rise of high deductible health plans and coinsurance, makes it difficult, if not impossible, for patients to adhere to their treatment plan, and

WHEREAS,       additionally, it is concerning that many of these plan changes have been implemented with little to no notification to the member. For those patients that do receive notification, the language can be difficult to understand, even for the most seasoned of healthcare experts, and

WHEREAS,       in many cases, there are only a few therapies available to treat patients with a chronic or rare condition, and it is incredibly unlikely that those few therapies have a therapeutically equivalent alternative. In the absence of copayment assistance, these individuals are often unable to afford their treatment. Biologics and other specialty therapies are often the only option for effectively treating these diseases, making affordability and access to these therapies critical, and

WHEREAS,       the Medical Society of Virginia, is deeply concerned about the issues mentioned above and the risks they pose to many patients with chronic and rare diseases, therefore be it

RESOLVED,     the Medical Society of Virginia urge the Virginia State Corporation Commission Bureau of Insurance to undertake an investigation into Healthcare Insurance Co-pay Accumulator programs to ensure patients can afford their medications.

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