South Dakotans may face higher medication costs under the new federal copay policy .
As out-of-pocket costs for prescription medications continue to rise, drug manufacturers are increasingly offering copay assistance that help people afford their medications.
But we at the National Alliance on Mental Illness (NAMI) South Dakota are worried that new federal policy that allows insurers to exclude that assistance when they calculate patients’ out-of-pocket maximum expenses could decrease the value of assistance to patients and ultimately increase their costs.
An estimated 113,000 adults in South Dakota have a mental health condition. Many, if not most, people battling mental illness rely on medications to help them manage their condition and improve their quality of life. But those drug treatments, frequently taken on an ongoing basis, can be expensive.
Copay assistance is a crucial support for patients trying to pay for their medications. And, when counted against the total out-of-pocket expense or annual deductible set by a health plan, they can help patients more quickly reach the point where their insurance coverage will pick up the entire cost of their prescriptions.
However, the U.S. Department of Health and Human Services (HHS) now wants to change an existing policy that requires insurers to count copay assistance toward the out of pocket limits. This new policy would let insurers count only the amount the patient pays for a prescription, not the total of their cash payment and the manufacturer’s contribution. That means some patients could eventually face a situation in which the copay assistance is used up before their deductible is satisfied. This could lead to unexpected bills at the pharmacy counter and increased costs for patients.
Having to pay more out of pocket for medications, even though patients have insurance, can be a huge financial burden. Some people trying to manage the symptoms of their mental illness might have to resort to rationing their drugs instead of taking the full dose their doctor recommends, or even leaving their prescriptions unfilled. This could have a profound effect on their lives when their untreated symptoms recur or worsen.
Allowing mental illness to go untreated can have multiple financial ramifications. Patients whose illness goes uncontrolled often end up in emergency rooms or the hospital, or make repeated trips to their doctors to get help. The expense of those treatments adds up, increasing costs for insurers and patients alike. Even our entire economy suffers, as depression and anxiety disorders alone cost an estimated $1 trillion a year in lost global productivity.
This policy revision could affect many South Dakotans, not just those taking medications for mental illness. Overall, a 2019 Consumer Reports study found that 30% of Americans taking a prescription medication had seen their out-of-pocket costs for a drug they regularly take increase over the year, with more than one in 10 of them seeing an increase of $100 or more. Patients of all kinds don’t need a new government policy that will make their prescriptions even more unaffordable.
NAMI South Dakota opposes this policy change, set to take effect next year. Please join us in making sure HHS realizes that copay accumulators are a bad idea and help us encourage insurers from disbanding accumulator adjustment programs within their plans.