State Rep. Four Price & Sen. Dawn Buckingham: ​​​​​​​CAAPs Hurt Sickest Texans Disproportionately

HB 2668 & SB 523 can achieve bipartisan goal of helping patients when they need it most

By Darla S. Bell

AUSTIN, Texas (Texas Insider Report) — 
The Texas Legislature, currently in session, only meets every other year. Yet it can make the most of its short time together by passing House Bill 2668 and Senate Bill 523, which would protect some of the most vulnerable Texans – those with rare and chronic diseases.

These bills ban health insurers' discriminatory use of Copay Accumulator Adjustment Programs (CAAPs), which devalue co-pay assistance – a.k.a. co-pay coupons or co-pay cards – that patients rely on to pay for their medications.

Rare and chronic disease patients have faced numerous recent threats, from a pandemic that disproportionately affects them to the ever-increasing cost of health care and coverage. Passing HB 2668 and SB 523, introduced by State Rep. Four Price (right,) and State Sen. Dawn Buckingham (in her doctor's office, below left,) respectively, can achieve the bipartisan goal of helping these patients when they need it most.

Co-pay assistance is a lifeline for many patients because it helps them access the medications they need to maintain their quality of life. In 2016, one-fifth of brand-name prescription medications in the private market were purchased with the help of co-pay assistance. Given the trend, that figure has likely increased over the past few years.

Yet health insurers have attacked co-pay assistance with their increasing use of CAAPs, which prevent patients from counting these dollars toward their deductibles. As a result, patients are on the hook for the full cost of their medications mid-year after their co-pay coupons run out.
 
CAAPs disproportionately hurt the sickest patients whose medication costs are far higher than average.

CAAPs have gone from a novelty to commonplace as part of a broader phenomenon of health insurance cost-shifting to patients. In my analysis, the vast majority of Texas healthcare plans incorporate them. It's time for a government response to protect patients.

I have been blindsided by CAAPs myself. I have a chronic medical condition that requires a specialty medication, which helps prevent the relapse of my symptoms, dramatically improving my livelihood. With an $8,000 annual health insurance deductible, I have relied on co-pay assistance to afford my medication.

Yet in 2019, my plan adopted a CAAP, leaving me on the hook for the full deductible.

Health insurers claim that by making patients pay their full deductible out of pocket, CAAPs encourage them to shop for less expensive drugs. Rice University health care economist Vivian Ho argues co-pay coupons "encourage overutilization of high-priced drugs."

Yet for many patients, it's impossible to shift to cheaper medications. By one estimate, nearly 90% of medications that offer co-pay assistance have no generic alternative.

Therefore, CAAPs threaten some patients' access to their prescription drugs. Research suggests patients with high-deductible health plans that include CAAPs fill their autoimmune prescriptions 23 percent less often and discontinue their treatment four times more often than comparable patients not subject to these programs.

CAAPs are penny-wise but pound-foolish. According to a review in the Annals of Internal Medicine, skipping Prescription Drugs causes 10% of hospitalizations and 125,000 deaths annually, costing the health care system hundreds of billions of dollars.

By passing these bills, Texas can follow in the footsteps of states such as Arizona, Georgia, Illinois, Virginia and West Virginia that have already outlawed CAAPs. Doing so can fix a pressing problem facing the Lone Star State's rare and chronic disease community, allowing us to focus on our health, not our finances.

Darla S. Bell is an energy executive and patient advocate who lives in Dallas. 
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