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Delaware Senate Democrats

Mantzavinos introduces legislation to make prescription drug coupons count

April 13, 2022

DOVER — Sen. Spiros Mantzavinos and Rep. Krista Griffith introduced legislation today to help make prescription drugs more affordable for Delawareans.

“Thousands of Delaware families — especially seniors and those living on a fixed income — struggle to afford their prescription medications and other health care costs,” said. Sen. Mantzavinos, D-Elsmere. “Sufferers of chronic illness are disproportionately targeted by rising prescription drug costs. As lawmakers, we should be doing everything within our power to ensure that consumers are receiving every eligible benefit and cost-sharing opportunity for their health care expenses.”

Senate Bill 265 would ensure that any third-party, cost-sharing assistance used by patients is applied toward their health insurance deductibles and any out-of-pocket limits. This bill also defines what constitutes a “cost-sharing requirement,” as well as how to calculate the assistance when applying to patient’s deductibles and out-of-pocket limits.

To help patients better access and afford their medications, many third-party entities offer cost-sharing assistance such as manufacturer copay coupons. Unfortunately, health insurers and pharmacy benefit managers (PBMs) have recently adopted policies, often referred to as “accumulator adjustment programs,” that block the value of manufacturer coupons from counting towards deductibles and maximum out-of-pocket limits, which effectively allows health insurance companies to pocket the value of the coupon. Many patients who rely on this assistance to access their medicines have no idea that health insurers and PBMs are no longer counting coupons towards their out-of-pocket limits.

Accumulator adjustment programs threaten to make it harder for patients to get important treatments for chronic illnesses like asthma, diabetes, HIV, arthritis, hemophilia, and others. Prohibiting “accumulator adjustment programs” would allow patients to enjoy the full benefit of coupon assistance programs meant to help them access and afford their medicines.

More than a dozen states including Connecticut and Virginia have already enacted legislation to address this issue. This bill applies to both insurance carriers and PBMs with an effective date of January 1, 2024.

“The cost of prescription drugs is a constant concern for so many Delawareans, particularly seniors and those living with chronic conditions, and we owe it to them to do everything possible to keep their medications as affordable as possible,” said Rep. Krista Griffith, D-Fairfax. “Especially as families are facing economic pressures for many other reasons, this small legislative change can make a real difference.”

SB265 has been assigned to the Senate Banking, Business, & Insurance Committee.