FOR IMMEDIATE RELEASE
STATEMENT FROM NCODA LEGISLATIVE & POLICY ADVISORY COMMITTEE
Contact: Kevin Scorsone | NCODA Legislative & Policy Liaison
Phone: (919) 903-2057
MAINE PUSHES FORWARD WITH COPAY REFORM
Copay accumulator reform has been sweeping the nation so far this year. We are thrilled that the state of Maine has passed sweeping copay accumulator reform that has resulted in SB 1783 being passed and enacted on April 25.
Starting on or after January 1st, 2023, this law makes sure that an individual’s health plan or pharmacy benefit manager does not exclude any waivers or discounts provided by third parties on behalf of the covered individual when the health plan calculates the individual’s contribution to any cost-sharing requirement of their health plan (including the deductible, copayment, and out-of-pocket maximum). These requirements do not apply for drugs with generic alternatives, unless the covered individual obtained the brand-name drug through a prior authorization, step therapy override exemption, or other exemption or appeal process.
By including any waivers or discounts provided by third parties on behalf of a covered individual and counting them towards the individual’s cost-sharing responsibility under his/her health plan, the covered individual will be able to get their prescription faster and easier.
NCODA firmly believes that states have taken notice of the reform currently taking place around the country. We believe that it is time for continued copay accumulator and PBM reform. Important updates such as this can be found in the newly released NCODA Oncology State Legislation Tracker. This state-of-the-art and first-of-its-kind tracker is updated weekly and features oncology related bills from all 50 states. The tracker includes the full bill to read, and also includes a summary and “why it matters” section to educate our membership in a thorough and timely manner. To access the tracker, click here.
If you have any further questions regarding policy news and/or NCODA legislative initiatives, email Kevin Scorsone (NCODA’s Legislative & Policy Liaison) at firstname.lastname@example.org.
NCODA is a leading non-profit association dedicated to empowering medically integrated oncology practices to deliver positive, patient-centered outcomes by providing leadership, expertise, quality standards, and best practices. For more information about NCODA visit www.ncoda.org or follow @NCODA on LinkedIn.