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Coalition seeks legislative fix on out-of-pocket drug costs


A coalition of health advocacy groups hopes to address high out-of-pocket prescription drug costs in Iowa, a move that’s facing opposition from health insurers who say they’re already responding to the marketplace. 

The Iowa Co-pay Choice Coalition, an alliance of patient groups focused on lowering out-of-pocket costs and making co-pays predictable, is supporting legislation that would require health insurers to offer a flat dollar co-payment option with no deductible for prescription drugs. 

The legislation, Senate Study Bill 3004, would help promote patient choice and medical affordability by ensuring that health coverage options are available to all Iowans, the coalition said in a statement. The bill is sponsored by Sen. Mark Segebart, a Crawford County Republican. 

“Rising out-of-pocket costs and the increased use of coinsurance is putting the cost of medical treatment beyond reach for many Iowa patients and their families, and forcing them to make heartbreaking choices, such as whether to cover the cost of necessary medications or put food on the table,” said Lynn Albizo, director of public policy for the Immune Deficiency Foundation, a member of the Iowa Co-pay Choice Coalition. 

Among other member organizations listed on the coalition’s website with the Immune Deficiency Foundation are NAMI-Iowa, the National Multiple Sclerosis Society, the Hemophilia Federation of America, the Alliance for Patient Choice, the National Organization for Rare Disorders, the National Psoriasis Foundation and the Arthritis Foundation. 

In an effort to encourage the use of cheaper generic drugs, Iowa health insurers are increasingly relying on “coinsurance,” which forces patients to pay a percentage of the total cost of their medication rather than a traditional, flat co-payment, according to the coalition. However, for those with serious chronic medical conditions, including leukemia, arthritis, multiple sclerosis, immunodeficiencies and others, coinsurance can put the cost of treatment out of reach. 

Lobbyists for Wellmark Blue Cross and Blue Shield, Anthem and the Iowa Federation of Insurers are registered in opposition to the bill. 

“Many insurers are already offering copay options because their customers are asking for them,” said Paula Dierenfeld, who represents the Iowa Federation of Insurers, whose members include Wellmark, UnitedHealthcare and other large payers in the state. “Prescribing this (approach) may limit the ability of companies to offer other plans that their customers want. What I’m hearing from (the health insurance) companies is that many of them are offering these kinds of plans.” 

Wellmark spokesperson Teresa Roof provided the following emailed statement on its position: “Wellmark administers health benefits for many groups and organizations. They depend on us to manage their health care dollars wisely and help them make good financial decisions.  Although this bill is well intended, it would significantly limit the products we design to meet our customers’ needs with the objective to improve cost transparency and consumerism.  This bill will ultimately result in higher health costs for everyone and because of that, we do not support this bill.”

Two states — Colorado and Montana — have adopted the no-deductible approach and have experienced little or no effect on premiums, the coalition said. 

The Iowa bill would require insurance providers to offer a minimum number of plans that provide a traditional copay option. Health insurers would still be able to offer other plans that rely on coinsurance. 

“Many Iowa families, including those who already have health insurance, have a difficult time managing their copays and deductibles. SSB 3004 gives those families more choice and predictability in managing their out-of-pocket costs,” Segebart said. 

For more information about the Iowa Co-pay Choice Coalition, visit its website here.

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