About Us

According to the Centers for Disease Control and Prevention (CDC), more than 6 in 10 Americans live with at least one chronic disease, and more than 25 million live with a Rare Disease. Fortunately, advancements in biopharma over the past decade have turned conditions that were once considered fatal or life-limiting into manageable illnesses.

But efforts by State governments and Pharmacy Benefit Managers --whether by accident or design--have threatened access to these innovative treatments and medications, putting millions of Americans lives at risk.

We need every state and Congress to recognize the complexity of our healthcare system and make sure that every American in need is able to get the treatment they need to live.

Copay Accumulators and Copay Maximizers

According to the Centers for Disease Control and Prevention (CDC), more than 6 in 10 Americans live with at least one chronic disease. Fortunately, advancements in biopharma over the past decade have turned conditions that were once considered fatal or life-limiting into manageable illnesses.

New innovative treatments can be costly, so drug manufacturers and patient advocacy nonprofits often offer patient assistance programs to help patients afford the medications until their insurance kicks in.

But starting in 2018, Insurers and Pharmacy Benefit Managers changed health care plans to include something called a copay adjustment program, which prevents any third-party assistance from counting toward patient’s deductibles and maximum out-of-pocket calculation.

We need every state and Congress to pass legislation that bans copay accumulator and copay maximizer programs. These programs limit the ability for patients with chronic illnesses to receive the most effective treatment for their illness.

Chronic Disease and Treatment

According to the Centers for Disease Control and Prevention (CDC), more than 6 in 10 Americans live with at least one chronic disease. Illnesses like Cancer, Diabetes, Cystic Fibrosis, Sickle Cell, HIV etc. were always considered life limiting, because they couldn’t be cured and would likely lead to the patient’s death, however advancements in biopharma innovation over the past decade have changed that. Scientists and Doctors have developed new medicines and therapies that have more than doubled life expectancies for babies born with Cystic Fibrosis, they’ve found a way to create an artificial pancreas to help people with type 1 diabetes live longer and fuller lives and in the past year alone, the FDA has approved 10 new therapies to treat/cure many types of cancer.

But the existence of a life-saving treatment and patients being able to access those treatments are two different realities. Americans spend more on prescription drugs than the residents of any other country in the world – an average of $1,300 per person annually according to the Organization for Economic Co-operation and Development. So it comes as no surprise that a Kaiser Family Foundation poll shows 1 in 4 Americans reporting difficulty affording their medicine.

Despite efforts by state and federal lawmakers to lower healthcare costs, the 2023 out of pocket limit for ACA plans is $9,100 for an individual and $18,200 for a family. And only after a patient/ their family spend this amount on deductibles, copayments, and coinsurance for in-network care and services, does their health plan kick in and cover the costs of covered benefits.

That puts many people, including those with chronic illnesses into an extremely fraught position because either they pay the price, or their health does. In order to help patients afford vital specialty prescription drugs, drug manufacturers often offer patient copay assistance programs. This comes in the form of coupons, vouchers, co-pay cards etc. There are also patient advocacy nonprofits and charities that provide co-pay assistance.

But Insurers and Pharmacy Benefit Managers believe that copay assistance encourages patients to receive/ and docs to prescribe the use of brand-name drugs over generics or lower cost brand-name drugs. So, they changed health care plans offered to include something called a copay adjustment program, which prevents any third-party assistance from counting toward patient’s deductibles and maximum out-of-pocket calculation.

However, 79% of branded medications with available copay assistance do not have a generic equivalent. This leads patients to not fill or to ration their medication, leaving their condition untreated.

The New England Journal of Medicine estimates that drops in adherence cause approximately 125,000 deaths and at least 10 percent of hospitalizations each year, and the financial cost of the American Health System totals more than $100 billion each year.

Obesity

Obesity is a serious chronic disease that impacts millions of Americans. It is directly linked to precarious health conditions, including diabetes, heart disease, diabetes, among others, resulting in 300,000 deaths every year. Despite the clear dangers of obesity, too many continue to hold the outdated belief that obesity is the result of an individual’s personal behavior and decision making. Instead, the reality is that this disease is the product of various biologic, genetic, and environmental factors. Now, in order to combat obesity, we must now fight back against the old, archaic perception of this disease while also providing patients with the treatments they need. The Centers for Medicare and Medicaid Services recently proposed that Medicare and Medicaid services allow for coverage of anti-obesity medications (AOMs) but we need widespread support so we can finally turn the tide against obesity.