© 2022 WKSU
Public Radio News for Northeast Ohio
Play Live Radio
Next Up:
Available On Air Stations

Prescription drugs are expensive. A new Ohio bill could bring relief.

i viewfinder
Medications can be too expensive, so copay assistance programs can help. But some say the cost just gets passed down the line when the patient still has to pay that money to reach their deductible.

For many Ohioans, prescription drugs are just too expensive — even with insurance. Copay assistance programs can offer some financial relief, but often patients end up paying full freight anyway because costs covered by those programs don't count toward their deductible.

That means even though they aren’t paying the full cost of their prescriptions, they end up paying that cost on other medical care until they hit their deductible.

A bill in the Ohio House aims to change that.

H.B. 135 bill would allow patients to count copay assistance programs toward their deductible, the amount a person has to pay out-of-pocket before insurance begins to pay. Advocates say this would allow patients to better afford care, and that it would alleviate some real hardships some people face when they get sick and can’t afford their medications.

"Health care in general is very expensive," said Leo Almeida, government relations director for the American Cancer Society, which is advocating for the legislative change.

And copay assistance programs, which are supposed to help alleviate some of that cost, aren't always helpful.

"Let's say you're picking up a prescription and your out of pocket for that prescription is $500. You have this copay assistance. The pharmacy applies the $500, so you get that medication for free that month," he said. "But your insurance company doesn't apply that $500 to your annual deductible. So therefore, it's a benefit at the pharmacy counter, but it's not a long-term benefit because you're still paying your same deductible through your insurance. So you essentially just pay it down the road."

Julie Turner from Tipp City, Ohio is a cancer survivor. After her chemo and radiation treatments she lost bone density, she said.

She's now on medication to treat that side effect, but the medication is really expensive, so she applied for and received copay assistance through her drug manufacturer.

But the copay assistance program didn’t help her much at all, she said.

“The assistance that I was so excited about — being a retired person on a fixed income — was going to help me, but in essence, it was no help at all," Turner said. "Because later in the year, I was paying back the $1,500 in my out-of-pocket maximum.”

That reality can especially be costly for people with chronic diseases. The average out-of-pocket spending in 2018 for people with diabetes was more than $2,000, according to an article in the Journal of the American Medical Association (JAMA). For about 8% of people, out-of-pocket spending is more than $5,000.

Insulin — a life-saving drug for those with diabetes — accounts for 18% of all out-of-pocket spending.

The PAN Foundation — which provides copay assistance — said has helped people with rheumatoid arthritis, people who need medication to improve their mental health and people with all types of cancers.

The situation for some can be so dire that organization said they have encountered people considering taking out a second mortgage on their house to pay for medications or skipped medication all together before they found copay assistance. Nearly 60% of Americans have delayed or gone without essential medical care because of high out-of-pocket costs and Medicare patients paid an average of $8,000 per person on medications in 2019, according to the foundation.

A recent survey found 51% of cancer patients and survivors had gone into debt to cover the cost of their cancer care, Almeida said.

“So if you think about that 51%, there are people who are deciding between putting food on the table for their family or paying for their prescription," he said.

H.B. 135 would help anyone whose medications are so expensive they need a copay assistance program, Almeida said. But advocates say they are concerned the bill is stalled.

In March, state legislators in the house voted unanimously to pass the bill, which means it has bipartisan support. Since then, it’s been sitting in the Senate Health Committee.

Lisa Ryan is a health reporter at Ideastream Public Media.