In our community, I know that many of us have concerns about the cost of health insurance and the availability of life-improving or live-saving medications. Just this year, drug companies have raised the wholesale retail prices on 450 medications. As for medication availability, recent surveys have revealed doctors and physicians struggling with burdensome prior authorization protocols that slow down or restrict their ability to prescribe medications for their patients.
Anne Carney
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 patients can get their prescription medications.
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 – stops manufacturer copay assistance coupons from counting toward both the patient’s deductible and maximum out-of-pocket spending. Sadly, the patient ends up paying more for the prescription drug, even though they needed financial help to pay for it in the first place. Patients can suffer financial hardship, especially when they need expensive medications.
For example, a patient might be taking a pre-exposure prophylactic (PreP) to prevent HIV named Descovy, which has a retail cost of $2,165.79. The drug manufacturer, Gilead, has a co-pay assistance (coupon) program that helps patients afford their medicine. However, if the patient’s insurance company uses a co-pay accumulator program, then the patient’s discounted co-pay does not count toward the patient’s annual out-of-pocket maximums. Eventually, the patient will end up paying their full deductible. Sanborn’s bill, LD 1783, would prevent double billing, which would protect Mainers from financial hardship and ruin when they need expensive prescription medications.
My colleagues and I are working in other ways to ensure that patients can access their prescription medications. Roeder’s bill, LD 1776, would allow pharmacists to dispense emergency supplies of medications to a patient when a prescription authorization is unavailable. As long as the pharmacist has a record of a past prescription, then they can provide medication to the patient.
The bill would require insurance companies cover the emergency medication supply. The bill would also give patients who are coping with chronic conditions, such as asthma, diabetes or a heart condition, peace of mind that they can access their medicine during an emergency.
On these issues, and others, my colleagues and I remain committed to helping Mainers live happy, healthy and full lives. I know there is much work ahead to make health care affordable for everyone, but I also know these two bills will alleviate the financial strains caused by high health costs and uncertain access to prescription drugs.
If you have questions about health care and medication, please contact Consumers for Affordable Healthcare. Its Consumer Assistance Helpline is 1-800-965-7476. If you ever need other assistance or want 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 Anne.Carney@legislature.maine.gov or 207-287-1515.
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