Blog: California is Lagging in Protecting Patient Treatment Access Resources
By Julie Gill Shuffield, Patients Come First California Executive Director
California is often a leader in championing progressive initiatives aimed at improving the quality of life for its residents, but on the issue of ensuring patients can receive the assistance they need to access medications, it has fallen significantly behind other states. The health and well-being of countless individuals is not just theoretical, it is a matter of life and death especially for those already burdened with chronic health conditions. Patients Come First is dedicated to raising awareness where public policy needs to focus on protecting patients and prescription drug programs are in desperate need of patient centric reform.
Copay assistance is one critical resource intended to help the most vulnerable patients receive the treatments they need. However, due to bad actors, loopholes have been discovered to use accumulator adjustment programs to avoid counting the assistance towards a patient’s deductibles and out-of-pocket maximums. Without this copay assistance, patients are forced to cover the full out-of-pocket expense, which they often cannot afford. One study demonstrated that 70% of patients will forego essential treatments once the amount they are forced to pay is $250. This is unacceptable and cannot continue.
The consequences of copay accumulators are particularly severe for individuals with chronic illnesses such as diabetes, autoimmune disorders, or cancer, who rely on consistent access to medications for disease management and quality of life. For these patients, interrupted treatment due to financial barriers can lead to exacerbated symptoms, disease progression, and even life-threatening complications. Moreover, the mental and emotional toll of navigating such uncertainties further compounds the already considerable challenges of living with a chronic condition.
I serve as the Executive Director of Patients Come First in California because the mission is personal to me as an asthmatic and mother of children living with asthma. Our asthma is well controlled through a series of physician and patient-led trial and error as medicines are introduced the market and as generics become available. Due to environmental allergies, depending on the time of year, having a disruption to my prescriptions or a requirement to switch medicines by my insurance company with little to no notice can quickly escalate my symptoms from a well-controlled disease to one requiring emergency medical intervention. This is short sighted and potentially deadly.
Copay accumulators argue that they control healthcare costs by incentivizing generic or lower-cost medications. However, this argument fails to acknowledge the fundamental flaw in this approach: it places the burden of cost containment squarely on the shoulders of patients when there are resources available to help. Furthermore, it disregards the fact that many patients require specific medications due to factors such as treatment efficacy, tolerability or medical necessity leaving them with limited alternatives. My asthma is well-controlled using a combination of generics where equivalent and specific formulary medicines. My understanding of my body and its response to medicine is something that cannot be determined by draconian attempts to regulate patient and doctor choice.
California is already lagging behind 19 other states, Washington D.C. and Puerto Rico in addressing these reforms. Failure to act on copay accumulators not only perpetuates inequities within the healthcare system but also undermines the state's commitment to promoting the health and welfare of its residents. Now is the time for decisive action to ensure that every Californian can access the medications they need without undue financial hardship. We implore California to recognize the harm caused by copay accumulators and keep patient choice at the center of the discussion. California needs to re-emerge as the leader of patient friendly reforms while allowing its patients to access the innovative medical treatments they are reliant on to live healthier lives.