Bipartisan Coalition of Legislators Introduces Legislation to Help Patients Overcome High Cost of Prescription Medications
MADISON – Today, Representative Lisa Subeck (D-Madison) joined a bipartisan group of legislators to introduce legislation that would ease the burden of prescription drug costs. The bill would ensure that the benefits of copay assistance programs offered by prescription drug manufacturers and other sources are realized by patients, not their insurance companies, by counting the savings toward deductibles and out-of-pocket maximums.
The proposal, introduced last session as Assembly Bill 184, was included as a policy to consider in the report of the Governor’s Task Force on Reducing Prescription Drug Prices convened in 2019 by Governor Tony Evers.
“Too many patients in Wisconsin struggle to afford needed medications,” said Representative Subeck, “Copay assistance programs and manufacturer’s coupons are one way to make health care a little more affordable, but only if the patient is the one who realizes the savings.”
Insurers and pharmacy benefit managers sometimes use a loophole in state and federal law which allows them to exclude coupons and other cost sharing assistance when calculating a patient’s out of pocket costs to determine whether deductibles or out of pocket maximums have been met. When a patient uses a coupon or other copay assistance, they reasonably expect that it saves them money. Unfortunately, that is not what happens when insurers and pharmacy benefit managers choose to keep those savings instead.
“If a patient uses a coupon to cover the cost of their prescription copay, it is only reasonable that they expect to be the one who benefits from the savings,” said Rep. Subeck. “Closing this loophole will provide an immediate benefit to patients by ensuring coupons and assistance programs can do what they are intended to do – help patients afford their prescription medications at the pharmacy counter.”
Rep. Subeck has represented the 78th Assembly District since 2015 and serves as Chair of the Assembly Democratic Caucus.