Global Healthy Living Foundation Launches Free Tool Demonstrating How State Laws Protecting Patient Assistance Programs Impact Health Insurance Premiums

The Global Healthy Living Foundation (GHLF) today launched a free, interactive tool that will provide legislators, policy makers, and interested parties with objective data demonstrating how U.S. health insurance premiums have fluctuated since 2014. GHLF analysis shows that, to date, there has been no statistically significant change in the rates of health insurance premium increases after the passage of state laws requiring that patient assistance funds count toward policyholders' deductibles or out-of-pocket (OOP) maximum payments.

Legislation is needed because insurance and pharmacy benefit management (PBM)-instituted accumulator and maximizer programs have shifted the burden of paying for expensive, brand-name drugs ? often used by the chronic disease community ? to individual patients. Accumulator programs prohibit the value of a manufacturer's co-pay or other support payments from counting toward patients' annual deductible and OOP maximum obligations. Maximizers set patients' OOP maximums equal to the maximum value of a manufacturer's patient-assistance program, which is typically spread evenly throughout the benefit year. Maximizer programs also do not allow manufacturer's co-pay or other support payments to count toward patients' annual deductible and OOP maximum obligations.

"Co-pay accumulator programs lengthen the amount of time it takes for a patient or family to reach their deductible and OOP limit, and an individual may only learn of their enrollment in such a program when they try to fill a medication and are told that they still owe the full price for that prescription in the middle of a plan year," explained Dr. Robert Popovian, PharmD, MS, Chief Science Policy Officer, Global Healthy Living Foundation. "Our analysis shows that the assertion made by insurance companies and PBMs that restricting accumulator and maximizer programs will cause higher health insurance premiums simply isn't true."

Dr. Popovian added, "Stakeholders involved in shaping state and federal health policy can use our tool to look at how health premiums have changed (or not) following laws being put in place that protect patients from very surprising and possibly very expensive medication bills."

In the U.S., over 90 percent of prescribed medications are available as generics. Most of the rest are specialty, brand-name medications, used disproportionately by the chronic disease community without generic or biosimilar options.

Calculating Health Insurance Premium Fluctuations

Using raw data from the HIX compare + website (Robert Wood Johnson Foundation), which provides data for most health insurance policies available through the Affordable Care Act (ACA) Healthcare Marketplace, GHLF created two separate databases to calculate average health insurance premiums for individual purchasers and small group purchasers. For plans available to individual purchasers, each state's average premium for each insurance metal tier (bronze, silver, gold, platinum) for every year from 2014 to 2022 was calculated and recorded for an individual adult and for a family of two adults and two dependents. For plans available to small-group purchasers, the same averages were recorded for the years 2014 to 2021. Averages were calculated as the sum of the health insurance premiums for all plans in a specific tier in a particular state divided by the number of available health plans for that tier in that state.

The second variable analyzed was the introduction of legislation protecting patient assistance programs by prohibiting accumulators and/or maximizers. Changes in the magnitude of the percent rate change in average premiums were compared as raw percentages and analyzed with repeated ANOVA measures to evaluate whether premium rate changes were significantly different from one year to the next. The analysis shows that across all "metal tiers," there has been no statistically significant difference in the rates of health insurance premium increases upon passage or implementation of legislation protecting patient assistance programs by prohibiting accumulator and/or maximizer policies.

"We plan to update this tool every six months to include additional states that enact new laws and to determine if premiums are changing over time. This tool will help stakeholders visualize health insurance premium changes year to year and, specifically, as related to restriction of accumulator and maximizer programs," said Louis Tharp, executive director and co-founder, Global Healthy Living Foundation.

Click this link to review GHLF data: https://www.ghlf.org/copay-assistance-protection

About Global Healthy Living Foundation

The Global Healthy Living Foundation is a 501(c)(3) nonprofit organization whose mission is to improve the quality of life for people with chronic illnesses (such as arthritis, osteoporosis, migraine, psoriasis, inflammatory bowel disease, and cardiovascular disease) by advocating for improved access to health care at the community, state, and federal levels, and amplifying education and awareness efforts within its social media framework. GHLF is also a staunch advocate for vaccines. The Global Healthy Living Foundation is the parent organization of CreakyJoints^®, the international digital community for millions of arthritis patients and caregivers worldwide who seek education, support, activism, and patient-centered research in English and Spanish through our ArthritisPower^® (ArthritisPower.org) Research Registry. In response to the COVID-19 pandemic, GHLF started a Patient Support Program, informed by a patient council made up of people living with a wide range of chronic illnesses, that now serves more than 46,000 subscribers. Via CreakyJoints, GHLF also hosts PainSpot (PainSpot.org), a digital risk-assessment tool for musculoskeletal conditions and injuries, eRheum (eRheum.org), for telehealth and virtual-care support, and a constantly refreshed library of podcasts via the GHLF Podcast Network. Visit ghlf.org for more information.

Find us online:

Global Healthy Living Foundation: ghlf.org

CreakyJoints Canada: CreakyJoints.ca

CreakyJoints: CreakyJoints.org

CreakyJoints Español: CreakyJoints.org.es

CreakyJoints Australia: CreakyJoints.org.au

Facebook: facebook.com/CreakyJoints & facebook.com/GlobalHealthyLivingFoundation

Twitter: @GHLForg, @CreakyJoints, #CreakyChats

Instagram: @creaky_joints, @creakyjoints_aus, @creakyjoints_esp

TikTok: globalhealthylivingfnd

LinkedIn: linkedin.com/company/ghlf

Global Healthy Living Foundation Podcast Network: https://ghlf.org/patient-education/listen/