Let’s Address the High Cost for Those Suffering with Chronic Illness

Over a decade ago, the California Healthcare Foundation conducted a landmark study among adults with chronic conditions in the state. The purpose was to explore the lives of Californians ages 18 and older with chronic conditions: their quality of life, factors relating to their health needs, their experiences with the health care system, and, in particular, the support and help they needed to better manage their health conditions.

The study included a sub-sample of Latinos who had at least one chronic condition, including heart disease, cancer, cystic fibrosis, stroke, diabetes, arthritis, asthma, high blood pressure, emphysema, chronic bronchitis, depression, and anxiety, among others.

Data from the study provided direction on the specific types of support Latinos with chronic conditions needed, as well as how to best provide that help. However, it also identified a real need to address barriers to chronic disease management, including many gaps in the health care system, all of which tended to disproportionately impact those with fewer choices available to them due to income level, health status, and insurance coverage.

After a decade, one would imagine significant progress related to the health and wellbeing of Latinos in California. Unfortunately, that’s simply not the case. While medical technologies and research advancements have been prominent, skyrocketing healthcare costs continue to burden patients suffering from chronic illness. One solution to addressing a financial inequity in our healthcare system is banning copay accumulators.

What are copay accumulators? They are a line of couple of sentences snuck into health plans a handful of years ago that shift more cost onto patients. After the Affordable Care Act passed, insurance companies and pharmacy benefit managers (PBMs) were no longer able to deny coverage of lifesaving care to their customers. So, they began to search for other ways to avoid covering the cost of more expensive medications and therapies.

More than 75% of this country’s healthcare costs are due to the rising price of specialty medications, which are medicines used to treat people with chronic illnesses. Many of the newest and most effective treatments have no generic and are therefore only affordable for patients because charities, non-profits and drug manufacturers stepped in and offered coupon cards, vouchers, and other forms of financial assistance. But when a plan contains the copay accumulator language, none of that assistance is counted towards a patient’s deductible, leaving patients and their families on the hook for thousands of dollars more per year. This can lead to crippling medical debt, and force patients to forego essential treatments.

For many Latino families in California, copay accumulators pose a significant threat to their financial stability. Today, the Latino community continues to be disproportionately affected by chronic diseases such as diabetes, heart disease, cystic fibrosis, and cancer, which require ongoing and often expensive treatments some beginning in childhood.

It is unacceptable that insurance companies use copay accumulators as a means of increasing their profits at the expense of their patients. A ban would ensure that patients receive the treatments they need, without facing undue financial burden. This is a matter of basic fairness and compassion, and the Latino community deserves no less.

As Californians, we are proud of our state’s commitment to health and wellbeing. Banning copay accumulators is a necessary step in upholding this commitment, and we urge our lawmakers to act swiftly. The health of our families and neighbors should not be put at risk for the sake of corporate profits. It is time to take a stand and ban copay accumulators in California.

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