(Update: adding video, comments from Rep. Levy, Pacific NW Bleeding Disorders, Cascade AIDS Project)
SALEM, Ore. (KTVZ) — This week, Rep. Emerson Levy, D-Bend, told the House Committee on Behavioral Health and Health Care that it's time to create co-pay fairness, which means if an Oregonian has insurance and receives financial assistance from a pharmaceutical manufacturer, that payment has to count toward their deductible.
“Legislation I bring before you today is the first step to bring balance to a system that has left patients unable to pay for expensive medication and therefore reliant on costlier emergency room care,” said Levy. “Oregonians that pay for their insurance should be able to use it, but because of co-pay limiter programs, each visit to the pharmacy counter can be a game of health care roulette.”
In Oregon, some patients have to either pay out of pocket for prescription drugs or stop taking them altogether because, under some commercial insurance plans, insurance companies aren't required to accept financial assistance toward an enrollee’s annual deductible. Discontinuation of medication can lead to irreversible or life-threatening health consequences for chronic disease patients, the lawmaker said in a news release.
Levy’s legislation, HB 4113, would require insurers to accept coupons or other third-party payment methods toward the enrollee's annual deductible to pay for life-saving medicines.
During a hearing Thursday, legislators heard from people impacted by the high cost of prescription drugs.
“There are not enough generic HIV treatment medications, so most people living with HIV rely on overpriced brand-name drugs,” said Jonathan Frochtzwajg, Public-Policy Manager for Cascade AIDS Project, the oldest and largest provider of services for people affected by HIV in Oregon.
He added, "It's really important to note that this bill only applies in situations where patients don't have a less expensive option."
For some, the only way to afford medication is by using co-pay assistance to reach annual deductibles.
“When insurance companies don’t count co-pay assistance toward consumers' deductibles, even for drugs with no generic equivalent, it puts people living with HIV at risk of falling out of treatment, and undercuts public health efforts to end the HIV epidemic,” Frochtzwajg said.
When medications are too expensive for a patient, it can lead to dangerous outcomes.
Levy said, "What we're seeing over and over again is that people are just not taking in their medication, and they're getting sicker or they're going to the ER, which is triple the expense. People not being able to get their medication is not a political issue. It's a human issue."
The executive director of Pacific Northwest Bleeding Disorders, Madonna McGuire Smith, supports the bill and says people with chronic illnesses face thousands of dollars a month in costs.
"My family has severe bleeding disorders and we have incredibly expensive medication," Smith said. "The very first order that we place at the beginning of the year helps us to meet our out-of-pocket max. In fact, my son's medication is about $45,000 a month -- and it's two shots."
Levy’s legislation has bicameral and bipartisan support, including support from Rep. Cyrus Javadi (R-Tillamook) and Sen. Tim Knopp (R-Bend).
"HB 4113 ensures that every dollar counts towards patients' out-of-pocket costs, making prescription drugs more affordable and health care more accessible for Oregonians," said Javadi.
If enacted, the legislation would impact the lives of Oregonians facing already high health care costs.
But some Oregon insurance companies are concerned about the unintended consequences. In a recent letter to the editor of The Bulletin, Cascade Insurance Center owner Patrick O'Keefe expressed his thoughts against passing the bill.
"Passage of HB 4113 would mean someone receiving the assistance for an expensive prescription may wind up having all the rest of their other insurance-related expenses covered in full." said O'Keefe. "While this may benefit those with expensive prescriptions, it isn’t logical and in the long run will ultimately increase the cost of insurance for everyone else."
Similar legislation is already in effect in 19 other states, including Texas and Washington.
"And in those 19 states that don't allow this practice, their rates have not gone up and Oregon's rates went up last year on the ACA marketplace," Levy said.
Missouri's legislature is considering the same measure this year.
HB 4113 will go to the House Committee on Healthcare on Wednesday. If it's passed in the work session, it will go to the House floor, and then possibly on to the Senate.