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Bill Would Require Insurers and PBMS to Put Co-Pay Assistance Towards Patients Annual Co-Pay Amounts

Wednesday, February 8th, 2023 -- 1:00 PM

(Bob Hague, WRN) Proposed legislation would require Wisconsin insurance plans and pharmacy benefits managers to accept co-pay assistance towards annual drug co-pays.

Insurance companies are telling Wisconsin patients like J.P. Summers that financial assistance from some sources doesn’t count towards their drug deductibles. “It's not fair for the insurance companies to accept these funds, use them up and then still expect the patient like myself to keep paying their deductible.”

The bill’s author, state Senator Andre Jacques of DePere on what he’d say to insurers. “Well, I think I would say you already got your money. That's kind of what we're talking about here. I mean, it's almost like a riddle you would tell your kids: when is a dollar not a dollar? When somebody says that it's not even though they pocketed it already.”

Patient Deb Constantine says insurers are accepting those payments and then billing patients again. “These policies require patients to pay the same amount twice, to get closer to their annual out of pocket limit or annual deductibles.”

Representative Lisa Subeck of Madison says bills banning the practice have been implemented in 14 other states. “And the sky has not fallen. Insurance companies haven't gone out of business, pharmacy benefit managers are still in place. And those costs to the patients for those insurance products have not gone up. So I think we have evidence that this works.”

The bill has bipartisan support in the legislature. 

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