Ohio House votes to end health insurance copay tactic that's 'ruining a lot of families'

The Ohio House passed a long-delayed bipartisan bill without opposition Wednesday  that is designed to enable Ohioans to better afford potentially life-saving medications.

The bill bans a practice known as a copay accumulator, in which health insurers refuse to count any copay assistance patients may receive from drugmakers, churches, nonprofits or family members toward the patient's annual maximum out-of-pocket payment.

House Bill 135, backed by more than five dozen groups ranging from the Ohio State Medical Association to The AIDS Institute, passed the House Health Committee unanimously on March 16, 2021. But it was mysteriously delayed from being brought to the House floor for more than a year amid opposition from health insurers and pharmacy benefit managers.

"It's been a long time coming," said Julie Turner of Vandalia, who ran into a copay accumulator that made it harder to get the medication she needed to treat bones weakened by intense radiation and chemotherapy treatments decades ago when she had stage 3 Hodgkin’s Disease as a teen-ager.

"It's going to help a lot of people, and not just cancer patients – those with chronic diseases that seek and get help on their medications," said Turner who watched the 89-0 vote from the House galley with several other cancer survivors.

Turner's struggles, as well as several others with rare or severe diseases, were featured in a Dispatch story last summer about copay accumulators. Another Dispatch story March 10 delved into the reasons behind the unusual hold-up on bringing the widely popular bill to the floor.

Ohio would join 12 other states and Puerto Rico in shielding constituents from health insurers' manipulation of copays. Another 15 states are considering similar legislation.

After the overwhelming vote, former state Rep. Randi Clites of Ravenna stood in the back of the House chamber with tears in her eyes.

"This is why I ran for the legislature in the first place," said the Democrat, whose son, Colton, 20, was born with severe hemophilia. Clites, who was a lawmaker in 2019 and 2020, said her health insurance costs $6,350 a month.  

"It's financially ruining for a lot of our families," she said.

Now policy director for the Ohio Bleeding Disorders Council, Clites said nine out of 10 insurers on the Affordable Care Act exchange in Ohio currently have some form of accumulator program that prevents co-pay assistance from counting toward maximum deductibles and out-of-pocket costs.

The approval came on Cancer Action Day at the Statehouse. The Ohio branch of the American Cancer Society honored the co-sponsors of HB 135 Wednesday morning: Reps. Susan Manchester, R-Waynesfield, and Thomas West, D-Canton.

Only those lawmakers testified on the measure, which now goes to the Senate.

Manchester said HB 135 would "remove discriminatory administrative practices that negatively impact consumers trying to beat their mandated health insurance cost-sharing practices."

The legislation "is needed to assist our constituents who find themselves increasingly subjected to more out-of-pocket costs as part of their insurance coverage."

West called the proposal "a patient friendly bill at its very core." And it addresses one of the main purposes he told voters to send him to Columbus: to lower the cost of prescription drugs.

The year-plus delay was blamed on Rep. Bill Seitz, a GOP leader from the Cincinnati area who wound up settling for an amendment of the bill.

"So there were some differences that we had to work through, and even some clarifications that needed to be made," Manchester said. "Look, at the end of the day we were able to come together and come around this bill."

Manchester said she hopes the bill wins approval in the Senate, especially after it sailed through the House without a dissenting vote.

"We want to make sure that patients continue to have access to their medications and that ultimately can access them at the lowest cost possible."