Point of View: Remove barriers that keep pharmacists from assisting patients
Diabetics shouldn’t have to ration their insulin, heart patients shouldn’t have to skip days of treatments to make their prescription last longer, and asthmatics shouldn’t have to decide whether to pay rent or get their inhaler. But as a pharmacist, I see patients making these impossible choices on a regular basis.
The No. 1 topic of conversation we have each day is not about health — it is about health care costs. And, while I wish the conversation was about prices going down, unfortunately that rarely happens. Many of my patients can only afford high-deductible insurance plans, which makes many prescriptions at the counter so expensive, they often choose to go without.
One way patients are receiving help is through co-pay assistance programs offered by a number of groups, such as pharmaceutical manufacturers and foundations. They provide support to patients (often with chronic complex conditions), by giving them cards or coupons to cover the cost of care.
Increasingly, I have seen the shock and devastation that comes when patients realize that their insurer is refusing to count co-pay assistance toward their deductible. Often by design, insurance jargon (deductibles, co-payments, maximum out-of-pocket costs, premiums, etc.) is hard to understand and explain to my patients.
One thing that is not hard to explain is that a dollar spent is a dollar spent. It should not matter where that dollar comes from. The reason pharmacists become pharmacists is to help patients, so it should not matter where a payment comes from. The patient should always be the one to see the benefit.
This practice is called “co-pay accumulator adjustments,” and it is often buried in the fine print of patient plans and contracts. Many patients are unaware of these programs until they arrive at my pharmacy counter to find their medicine is unexpectedly being withheld until they pay thousands of out-of-pocket dollars. Meanwhile, insurance companies get the value of negotiated price discounts from manufacturers despite ignoring the value of co-pay assistance programs.
For many patients, co-pay assistance programs are critical as the only way they can afford the care they need. But this practice by insurers is increasingly shifting costs to patients, and that puts patients at risk. Denying co-pay assistance can cause otherwise stable patients to ration or discontinue their treatment, leading to serious, even life-threatening, complications.
But relief for Oklahomans could be on the way. House Bill 3737, introduced by Rep. TJ Marti, would require health insurance companies to count all payments made by patients directly or on their behalf toward their overall out-of-pocket maximum payment or the patient’s deductible. The bill passed the House of Representatives with a vote of 93-0. It now goes on to the Senate.
Co-pay accumulators are just one of many predatory practices driving up costs for patients. Oklahomans are fortunate to have Reps. Marti, Jon Echols and Marcus McEntire, and Sens. Greg McCortney and Rob Standridge working to protect patients and their pharmacies from predatory practices from secret middleman (known as Pharmacy Benefit Managers or PBMs) that continue to generate outsized profits for their out-of-state shareholders.
I urge the Legislature to continue doing its part to remove the barriers that stand in the way of pharmacists helping people and building a healthier Oklahoma.
Lackey is a pharmacist and pharmacy owner in Fairview.