MADISON, WI, March 4, 2024 – Today, more than 40 national and Wisconsin-based advocacy organizations that make up the Wisconsin All Copays Count Coalition called on members of the Wisconsin State Legislature to cosponsor bipartisan Cole’s Act legislation that would help Wisconsin patients access and adhere to their prescription medications. This legislation would ensure that commercial health plans and PBMs in Wisconsin count the value of copay assistance toward patient cost-sharing requirements while still allowing insurers to retain plan design flexibility. Additionally, this legislation would close the loophole that allows insurers to define prescription drugs as non-essential and therefore not eligible to count toward their deductible.
“Cole’s Act presents a clear solution to ensure vulnerable patients can benefit from copay assistance and adhere to medically-necessary drugs for complex and chronic conditions,” said Rob Gundermann, President and CEO of the Coalition of Wisconsin Aging and Health Groups (CWAG) and lead member of the Wisconsin All Copays Count Coalition. “Today, a majority of commercial health plans in Wisconsin include policies that don’t count copay assistance towards patient’s cost-sharing requirements. Wisconsin should follow the lead of 16 other states and take immediate action on this legislation to ensure patients can access the medications they need to survive.”
More frequently, commercial health insurance plans in Wisconsin and states across the country are implementing copay accumulator adjustment program policies that don’t count the value of copay assistance toward a patient’s annual deductible or out-of-pocket maximum. These policies allow health plans to increase their profits by requiring patients to pay the same amount twice to get closer to their annual out-of-pocket limit. A 2023 report from The AIDS Institutefound that 8 out of 13 commercially available insurance plans in Wisconsin are implementing copay accumulator policies.
About the Wisconsin All Copays Count Coalition:
The Wisconsin All Copays Count Coalition is comprised of over 40 national and Wisconsin-based patient, provider, and physician groups serving the interests of patients with chronic and serious health conditions that rely on copay assistance to access critical medications.
