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Are You Covered? What MA Consumers Need To Know About Pharmacy Middlemen Impacting Prescription Drug Coverage

New co-pay "accumulator" programs can unexpectedly cost patients thousands of dollars

BOSTON - Oct. 29, 2018 - PrZen -- As consumers across Massachusetts look to purchase or re-new their health insurance plans for 2019 during Open Enrollment season (November 1st-December 15th) Patients for Prescription Access is urging consumers to read the fine print and make sure they have the best information on how the emerging role of Pharmacy Benefit Managers can impact out-of-pocket costs for prescription medications.

In recent years, the role of the Pharmacy Benefit Manger (PBM) has skyrocketed, along with this unregulated industry's profits.  PBMs are routinely finding new ways to shift costs to consumers.   The latest trend impacts patients with chronic illness who need and have been given co-pay assistance from prescription drug manufacturers.

Until recently, manufacturer co-pay assistance has benefited many vulnerable chronic disease patients; by allowing those dollars to meet high deductibles and out of pocket expenses; however, many health plans and PBM's are adopting what is known as copay accumulator adjustment programs, that identify these dollars and no longer allow them to meet a member's out of pocket responsibility.

"We've seen some alarming changes in the way insurance companies and their Pharmacy Benefit Managers are manipulating patients and their health coverage in order to pad their bottom line," said Richard Pezzillo, Executive Director of the New England Hemophilia Association and co-Chair of Patients for Prescription Access.  "For patients living with expensive to treat, chronic diseases like Hemophilia, even the thought of not being able to use co-pay assistance is devastating."

"You have to ask yourself, what's insurance for if not to help making treatment of a patient's disease affordable?" asked Carl Scortino, Executive Director of AIDS Action Committee and co-chair of Patients for Prescription Access.  "Patients living with chronic illness need reliable, affordable coverage for their medications and can't be allowed to be manipulated at the whim of insurers."

When reviewing health plan options during open enrollment, patients should ask about the use of manufacturer copay assistance cards, if the use of the discounts can change.


Patients for Prescription Access is a coalition of patient advocate groups and individuals who are committed to making access to affordable medication a reality for Massachusetts residents regardless of their medical conditions.


Jen Daly

Source: Patients for Prescription Access
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