Patient Advocates Thank State House Members for Bipartisan Vote Approving Bill to Ensure All Copays Count

LANSING, MI –Michigan’s leading patient advocacy organizations today thanked members of the state House of Representatives for their overwhelming bipartisan support for House Bill 4353, legislation that will guarantee insurance companies count all copayments made by or on behalf of Michigan patients.

Now on its way to the state Senate, the legislation would prevent an increasingly common practice used by insurance companies and pharmacy benefit managers called “copay accumulator adjustment programs” that exclude copay assistance payments from counting toward the patient’s deductible or out- of-pocket maximum.

For individuals living with rare and chronic conditions, like cancer, hemophilia, arthritis and many more, access to effective treatment is often made possible through copay assistance.

“Copay accumulator adjustment programs are detrimental for patients with chronic or rare conditions, such as hemophilia, as these insurance programs can prevent patients from affording necessary treatments,” said Sarah Procario, Advocacy Director for the Hemophilia Foundation of Michigan, and leader of the Michigan All Copays Count Coalition. “Patient advocates are grateful for today’s overwhelming, bipartisan support from the state House. We ask the state Senate to take up the bill right away so Michigan patients will be able to afford the treatments they need to live healthy lives.”

House Bill 4353, sponsored and championed by state Representative Bronna Kahle, acknowledges that copay assistance is real money and stops this discriminatory insurance practice. Under copay accumulator adjustment programs, out-of-pocket costs are paid twice, first from copay assistance and then from the patient.

“All 9 of the plans on the marketplace say that my copay assistance will not be counted toward my deductible or out-of-pocket maximum,” said Shelley Jeltema, a Lansing resident living with rheumatoid arthritis and psoriatic arthritis who testified recently before the House Health Policy Committee in support of the bill. “I feel like I’m being discriminated against for needing copay assistance to afford my medication which is literally the difference between being able to work or suffering disabling joint damage.”

Said Jaime Lyn Moy, a Waterford mom who testified in support of HB 4353: “My son, Andy, and I both have psoriasis and psoriatic arthritis. Andy has been through a lot. When his psoriasis flares, he is covered head to toe with burning, itching and pain. The psoriatic arthritis affects his joints, especially his spine and hips.

“Between the two of us, the out-of-pocket costs for our quarterly injections are almost $4,000. We both use copay assistance from the drug manufacturer to afford these out-of-pocket costs. Having to find over $10,000 every year to afford the biologics that keep us healthy and keep my son out of a wheelchair is unimaginable.”

The House approved HB 4353 today with an overwhelming, bipartisan 98-9 vote.

Said Kristen Stiffler, State Government Relations Manager for the National Psoriasis Foundation:

“Eighty percent of patients with psoriatic disease rely on copay assistance to afford their biologic treatment, and today’s vote in the House was an exciting step towards protecting their access to affordable treatments. Now, the Senate has the opportunity to end this discriminatory practice and guarantee access to necessary treatments, which is great news for Michigan patients.”

Members of the new Michigan All Copays Count Coalition include: