Prior to serving on the City Council, I spent nearly 20 years working to reduce health disparities in the same community I now represent on the council. Chronic disease disproportionately impacts communities of color and those living in poverty. I’ve seen this to be true on both a community level and on a personal level. I am a Black woman, and I am also a cancer survivor. In my 30s, I had seven years of chemotherapy. My life was saved by modern medicine, and I am so grateful. That doesn’t mean it was easy. Chronic and life-threatening disease is physically, emotionally, and financially draining.
I am glad I could afford the treatment I needed to save my life. But the challenge continues to be access for many others who are living with cancer, cystic fibrosis, or other chronic illnesses. Unfortunately, treatments and drugs are only effective if they are accessible and affordable. Until recently, there was at least one solution to this problem.
Beginning a half decade ago, insurance companies and pharmacy benefit managers (PBMs) found loopholes in laws by inserting new language into health plans known as copay accumulators. These loopholes categorized new treatments or drugs as “non-essential,” even though for almost 80% of circumstances, there are no generic options available. As a result, insurers don’t have to count funds given by third parties for “non-essential” drugs toward their customer’s deductible, even though insurers happily accept the money from assistance programs. This forces patients to pay thousands more to reach their out-of-pocket maximum and becomes extremely problematic for patients with chronic illnesses like those who are born with cystic fibrosis or those who develop cancer.
To help put this into perspective, prior to 2018, pharmaceutical companies and nonprofits could step in to provide financial support to patients through copay assistance programs. These programs helped reduce out-of-pocket payments for medications and treatments. The cost covered by the program was intended to be put toward a patient’s insurance deductible, allowing them to hit their out-of-pocket maximum, which allowed their insurance to cover costs sooner. But the loopholes give PBMs and insurance companies the ability to maximize their profits even further.
Surprise bills and expenses are all too common when it comes to dealing with medical emergencies and treatments. Unfortunately, most people impacted don’t know their health plan has a copay accumulator or maximizer program until a bill shows up after they thought their deductible was met. This circumstance leaves many people unable to continue using the best treatment available to treat or manage their illness.
Last year, then-Rep. Rena Moran and Sen. Mary Kunesh authored bills in the Minnesota House and Minnesota Senate that would ban copay accumulators. However, the legislative session ran out of time and neither bill passed out of committee. We need to urge our legislators to not forget about this important bill. Folks cannot afford to have their life-saving treatments put out of financial reach. Legislation like what was proposed last year would update our laws to prohibit insurers and PBMs from continuing this price gouging practice and enable patients to access the lifesaving medications they need.
We need these protections passed at both the state and federal level to protect patients from insurers profiteering off their illnesses. Please join me in urging state legislators to prioritize reducing healthcare costs, especially for those with chronic illnesses, and asking our members of Congress to support the HELP Copays Act this year. This policy would directly benefit many of the people I represent on the City Council as well as people all across our state who shouldn’t have to sacrifice their financial well-being for life-saving medication.
LaTrisha Vetaw represents Ward 4 on the Minneapolis City Council.