SC bill would ban insurance company program that burdens chronically ill patients | Opinion
We all know someone who has struggled with the cost of health care. In many cases, particularly with chronic illnesses, the costs become so expensive, many patients find themselves having to make the difficult decision of whether to pay for food or gas or their medicine.
Here in South Carolina, six out of 10 adults suffer from a chronic disease like diabetes, cancer, cystic fibrosis, or hemophilia. Nationally, 7% of adults could not pay for at least one medicine in their household. These alarming statistics are even higher among minority communities. And, on top of all these challenges, Americans pay three times as much for the exact same brand of medication as patients in other countries.
At the same time, major advancements in treatments for chronic conditions have been made over the past few decades. These new medications can have a life-changing, positive impact on patients and greatly decrease their suffering. Most recently, the FDA approved a drug that could significantly improve the lives of the millions of Americans who suffer with Alzheimer’s and therefore also their caretakers. Now, many can live longer, happier lives than ever before.
Well, only if they can afford it.
Health care access and its high cost is a complex problem that cannot be fixed overnight. Fortunately, there is a small change we can make that will have a big impact on those facing life-threatening chronic diseases. We can ban a new program called “co-pay accumulators” that has been quietly inserted into the fine print of insurance policies in the last few years, causing patients to pay even more for life-saving treatments.
Until recently, if someone was unable to afford the medicine they needed, there were options for help. Many non-profits stepped in to fill the gap with charitable dollars, and in some cases drug manufacturers would offer discounts. These contributions would normally help defray the patient’s copay at the pharmacy counter and would count toward their insurance deductible. So, after several months of paying for their medication, a patient’s out-of-pocket maximum would be met and full insurance coverage would kick in, lowering their costs to a more affordable amount.
So what changed? The old adage “follow the money” will give us the answer.
A couple of years ago, insurance companies started categorizing new and proven treatments as “non-essential,” even though there are no generic or equivalent options available. For plans with the new “co-pay accumulators” policy, insurers no longer have to count funds given by charities and manufacturers for drugs towards their customer’s deductible. Mind you, insurers are still happy to take the money from these assistance programs — greatly diminishing how much those dollars can help patients.
When this happens, patients are faced with the horrifying reality that they cannot afford to continue to use the best treatments for their illness. We must stop this practice now. It does nothing more than boost insurers’ profits at the expense of a patient’s health.
Fortunately, we have an opportunity to get rid of this program and help ensure patients can access the care they need. There is legislation in the General Assembly (H3537) to eliminate co-pay accumulator programs and require health plans to go back to applying co-pay assistance benefits to the patient’s deductible. If it passes, South Carolina will join nearly 20 other states who have passed similar legislation in response to this predatory policy.
The type of innovation that led to these remarkable medical advancements is the bedrock of our great nation. Yet, we must also remember compassion is at the center of who we strive to be as Americans. Patients who are already suffering should not be further victimized by underhanded ploys to increase a company’s bottom line. Our country and its people deserve far more than shady business practices.
Sen. Gerald Malloy, D-Darlington, is an attorney. He has served in the state Senate since 2002.
