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

July 1, 2012

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.

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