Putting Delaware patients first: Protecting Patient Assistance Programs

Patients with chronic health conditions in Delaware are seeing a new wave of relief thanks to Governor John Carney, members of the Delaware legislature and more than 40 patient groups. The recently passed SB267 will make it easier for vulnerable patients to be able to afford their brand medications.

Insurers and middlemen, like pharmacy benefit managers (PBMs), are increasingly shifting more costs to patients through high deductibles and coinsurance. Patients arrive at the pharmacy counter to fill their prescriptions only to find out that their insurance coverage isn’t what they expected it to be. To help fill the gap, biopharmaceutical companies offer cost-sharing assistance (also known as copay coupons) and other forms of patient assistance.

Unfortunately, an increasing number of insurers and PBMs are banning cost-sharing assistance from counting toward patients’ deductibles and out-of-pocket maximums. They call these accumulator adjustment programs. SB267 puts a stop to these middlemen schemes. Under the new law, most state-regulated entities providing health insurance in Delaware must now count cost-sharing assistance toward patient deductibles and out-of-pocket maximums. This can help patients get the medicines they need and afford their out-of-pocket costs.

With this law, Delaware joins 15 other states in protecting cost-sharing assistance, including Arizona, Arkansas, Connecticut, Georgia, Illinois, Kentucky, Louisiana, Maine, North Carolina, Oklahoma, Tennessee, Virginia, Washington, West Virginia and Puerto Rico. 

But it shouldn’t matter where you live — if you’re getting cost-sharing assistance to help access and afford your medicines, the assistance should count toward your deductible and out-of-pocket maximum. It’s time to ask other state legislators and policymakers at the federal level: What are you waiting for? Protect patient assistance and make coupons count. It’s the right thing to do.

Learn more at PhRMA.org/Middlemen.