Both the House and the Senate have included in their FY 2013 budgets a provision that allows co-pay assistance programs to be used in Massachusetts.

Massachusetts is the only state that doesn’t allow the use of such programs so residents do not get the same quality health care that the other 49 states enjoy by allowing patients access to prescription co-pay assistance programs.

Co-pay programs provide financial assistance for certain health care costs to patients who qualify financially and medically and greatly reduce the out-of-pocket expenses of patients.

The Senate version has a provision that would make it difficult to administer such co-pay assistance programs and would require that manufacturers create “Massachusetts only” co-pay assistance programs versus allowing patients to access to established national co-pay assistance programs.

The Senate needs to take out amendment 655.1  so that patients in Massachusetts can actually use the program and  biopharmaceutical companies don’t have unworkable administrative and regulatory mandates.

Here are some further details for patients in Massachusetts about the Co-Pay Assistance Programs provided by Massachusetts Biotechnology Council (MASS Bio).

  • Co-payments (“co-pays”) are portions of prescription drug costs that patients pay out of pocket and are set by health insurance companies. Between 2000-2009, insurance co-payment amounts increased 25% for generic drugs, 80% for preferred drugs, 59% for non-preferred drugs, and 44% for fourth-tier drugs.
    • To help patients, biopharmaceutical manufactures offer co-pay assistance programs that offset the cost of their high insurance co-pays for prescription drugs when the patient’s physician determines to a drug to be medically necessary.
    • Real life example: Massachusetts resident Joan Shaughnessey, 50, suffers from Multiple Sclerosis and must take the MS drug Copaxone.  Her insurance drug co-pay costs her $8,000 per year for the drug. If enacted, the co-pay assistance amendment would allow her access to a manufacturer co-pay assistance program that would reduce her out-of-pocket costs to just $35 per month.
    • Co-pay assistance programs are not “coupons” or clippings from the Sunday newspaper. They are established national programs that offer patients assistance in 49 US states.
    • Co-pay assistance programs would not apply to publicly funded programs such as Medicaid or Medicare and therefore would have no affect on government spending.

The “Perpetuity” provision (Senate Amendment 655.1) is impracticable, conflicts with established national programs, and would likely ensure that few – if any – patients in Massachusetts would get assistance with their out-of-pocket drug costs

    • Co-pay assistance programs are national in scope. This amendment would conflict with national programs by placing unworkable administrative and regulatory mandates that would only apply to Massachusetts.
    • This would require that manufacturers create “Massachusetts only” co-pay assistance programs versus allowing patient access to established national co-pay assistance programs.  This would create unneeded costs, additional bureaucracy, expose manufactures to punitive civil penalties, and would deter manufacturers from introducing programs in Massachusetts.
    • By making co-pay assistance financially and administratively problematic in Massachusetts, a perpetuity provision would make Massachusetts the only state in the nation that effectively denies its residents a critical benefit to offset the rising cost of health care.
    • Conversely, the amendments already agreed to by both the House (#336) and Senate (#655) would prohibit the use of co-pay assistance programs when a generic drug is available, would maintain the primacy of the generic substitution law, and therefore would not affect the state’s high generic substitution rate.
    • In sum, the “perpetuity” amendment would negate any potential benefits for Massachusetts patients that could otherwise be realized under the consensus co-pay assistance amendment as agreed to by both the House and the Senate.

1 thought on “Co-Pay Assistance Programs in Massachusetts – Why “Perpetuity” Provision (Senate Amendment 655.1) Will Not Help Patients”

  1. Chris Hempel says:

    UPDATE ON THIS ISSUE

    MassBio Commends Governor, Lawmakers for Ensuring Patient Access, Physician Education
    July 8, 2012

    MassBio Commends Governor, Lawmakers for Ensuring Patient Access, Physician Education

    July 8, 2012 (CAMBRIDGE, MA) — MassBio applauded Governor Patrick and the state legislature for including provisions in the Fiscal Year 2013 budget that allow Massachusetts residents to take advantage of co-payment assistance programs and ensure appropriate relationships between industry and providers.

    “We strongly commend Governor Patrick for signing the FY2013 budget, addressing two important issues – industry/provider interaction and patient access. This sends a message that Massachusetts is truly the leader in life sciences,” said Robert K. Coughlin, President & CEO of MassBio, which represents 600+ life sciences companies and organizations in Massachusetts. “We are not world leaders by accident, but because of leaders like Governor Patrick, Speaker DeLeo, Senate President Murray and their dedicated members—who went through a thoughtful and deliberate process in which they were determined to get it right – and they did.”

    The final budget, which was supported by the House and the Senate, allows Massachusetts patients to use co-payment assistance programs to keep down the cost of out-of-pocket expenses and improve medication adherence. Until now, Massachusetts was the only state in the country which did not allow access to these programs.

    “Governor Patrick has, once again, demonstrated his commitment to an industry that is vital to the future of our state’s economy, but more importantly to the patients both near and far who await the next breakthrough therapies that will improve their lives,” said Geoff MacKay, President & CEO of Organogenesis Inc. and Chairman of the Board at MassBio. “Any questions about Massachusetts’ pre-eminence in our industry were answered in the final version of the budget, which was thoughtfully prepared by Speaker DeLeo, Senate President Murray and their dedicated members, and strikes a true balance between bolstering innovation and minimizing barriers to patient access.”

    James Hoyes, President of EMD Serono, said, “EMD Serono applauds Governor Patrick and the leadership of the Massachusetts legislature for their support of increased access to medicines for the people of Massachusetts. This important change to allow co-pay assistance programs, enacted as part of the FY2013 budget, will enable companies like EMD Serono, Inc. to offer the same benefits to Massachusetts residents as other patients around the country. We at EMD Serono are very proud of our co-pay assistance programs which pay a portion of, and in some cases the entire co-payment for eligible patients, many of whom otherwise could not afford their prescription co-payments.”

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