Bipartisan Bill S3818/A5217 Can Ensures All Medical Copays Count and Help Vulnerable Families
Photo from FRNJ Files courtesy of Quinton Law.
Op-Ed
BY QUINTON LAW | American Cancer Society Cancer Action Network
Most New Jerseyans understand what it means to make hard financial choices, especially as the cost of living continues to rise. For patients living with cancer, these choices can be devastating.
When the price of treatment becomes too much to bear, the affordability crisis stops being about daily tradeoffs and becomes a matter of survival.
Every day, I hear from cancer patients across New Jersey who tell me that they face a cruel dilemma: if I get sick, do I pay for the medication that keeps me alive, or do I cover this month’s rent?
These are hardworking, earnest people, many of whom have health insurance, and the sacrifices they are considering pit their physical health against their financial health.
An insurance practice known as a “copay accumulator adjustment program” is contributing to affordability challenges. Under these programs, when a patient uses third-party copay assistance, such as funds from a charity, to help pay for their prescription, insurers and pharmacy benefit managers (PBMs) accept this money.
However, they do not count these payments towards the patient’s annual deductible or out-of-pocket maximum, which is the amount the patient must pay before insurance begins to cover costs. It’s a little-known insurance loophole that leaves patients with surprise bills.
Here’s what that looks like in practice: it starts with a cancer patient who is prescribed a medication for their treatment, which costs thousands of dollars. As they consider how to pay these exorbitant costs, they may find opportunities for third-party assistance to help them. Suppose this cancer patient’s deductible is $2,000, and they receive $2,000 in assistance.
That patient rightly believes they’ve met their obligation until they’re told at the pharmacy counter that they still owe thousands before coverage kicks in. Their relief turns to shock as they realize the assistance that was meant to help them doesn’t count because their insurer decided it shouldn’t.
This is devastating for those fighting cancer, one in five of whom will skip or delay treatment because of cost. Among Black, Hispanic and Asian patients, that number is even higher. With nearly 60,000 New Jerseyans expected to be diagnosed with cancer this year, it’s time for the Legislature to step in and protect patients from being punished for seeking help.
At a time when leaders across the political spectrum, from Governor-elect Mikie Sherrill to President Donald Trump, are talking about affordability and how government can ease financial pressures on working families, this is one area where action can make an immediate difference. Protecting patients from unfair insurance practices is a simple, bipartisan step toward tackling the affordability crisis head on.
The solution is S3818/A5217, bipartisan legislation that ensures all copays count—whether paid directly by a patient or through an assistance program.
The bill has already advanced with broad bipartisan support. Now it’s up to the bill’s prime sponsor, Senate President Nick Scutari and Assembly Speaker Craig Coughlin, to post it for a vote before the end of the legislative session so Governor Murphy can sign it into law.
Twenty-five other states, Washington D.C. and Puerto Rico have enacted laws ensuring all copays count. The American Cancer Society Cancer Action Network, the cancer community we represent and the public health leaders we stand alongside are calling on New Jersey lawmakers to join them and end this copay diversion scheme.
Speaker Coughlin and Senate President Scutari, patients across New Jersey cannot wait any longer. Posting this bill is one of the most immediate, meaningful actions the Legislature can take to ease the financial burden on families fighting cancer. This is our moment to lead and make New Jersey a state where every dollar patients spend on their care truly counts.
EDITOR’S NOTE: Quinton Law is the New Jersey Government Relations Director for the American Cancer Society Cancer Action Network. He is also the history-making mayor of Moorestown.
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