Senate enacts Sanborn bill to prevent insurance companies from double-billing patients for prescription drugs

Posted: April 27, 2022 | Senator Heather Sanborn

AUGUSTA – On Monday, the Maine Senate enacted a bill from Sen. Heather Sanborn, D-Portland. The bill, LD 1783, “An Act To Require Health Insurance Carriers and Pharmacy Benefits Managers To Appropriately Account for Cost-sharing Amounts Paid on Behalf of Insureds,” would prohibit insurers from implementing “co-pay accumulator programs,” which effectively double-bill patients who receive financial assistance for their prescription medications. 

“Mainers who deal with chronic conditions are often forced to rely on outrageously priced medications on an ongoing basis,” said Sen. Sanborn. “At times, patients are able to receive some limited financial assistance to put toward their prescription, like a prescription savings card, which can ease the burden. However, many insurance plans have begun not counting that money paid on behalf of the patient toward the patient’s deductible or out-of-pocket maximum, despite the fact that the insurer receives those funds. This effectively negates any benefit for the patient and the purpose of the assistance in the first place. This bill rightfully prohibits this practice, and I thank my colleagues for their support.” 

Co-pay accumulator programs essentially double-bill patients for their prescriptions. When a patient receives financial assistance from a drug manufacturer or third party, they are able to use those funds to help afford their prescription until the assistance lapses, but the insurance company does not count those funds toward their deductible or out-of-pocket maximum. These patients are then forced to come up with money that they weren’t planning for and that they didn’t have to begin with, which is what led them to seek financial help. If patients can find the money to continue treatment, it will likely be by making sacrifices in other parts of their life, like food or heat. If they can’t, they could be forced to stop treatment.

As amended, LD 1783 would require insurance companies to include any financial assistance used by a patient to pay for a medication when calculating their deductible and out-of-pocket maximum. The bill also ensures that consumers who utilize co-pay assistance know how much total assistance is available to them and for how long it will last.

The bill now goes to the desk of Gov. Janet Mills, who has 10 days to sign the bill into law, veto it, or allow it to become law without her signature.