Kentucky recently took a stand and became the first state in the U.S. to pass legislation that allows charities to assist patients with their health care costs, including insurance premiums.
Senate Bill 44, sponsored by Sen. Ralph Alvarado and Rep. Kim Moser, passed in 2021 and was improved and updated with a minor change (SB 317) in 2022. Accessia Health (formerly Patient Services Inc.) was proud to lead the lobbying efforts to obtain this win for patients. Accessia Health is a nonprofit patient assistance organization serving people with rare and chronic medical conditions. Our mission of more than 30 years is to provide financial support and guidance for qualified individuals by offering health care education, financial assistance, specialized legal services, and case management.
When we pioneered this need-based model, we sought guidance from the Office of the Inspector General (OIG) for assurance that if we solicited donations from pharmaceutical companies to help pay for health care for patients with specific diagnoses, we would not see repercussions from the Anti-Kickback Statute. We received the first OIG Advisory Opinion in 2002 and a modification to that opinion in 2017. These Advisory Opinions establish the framework by which Accessia Health operates. We ensure that every patient is treated fairly and consistently in accordance with established eligibility criteria and that our donors are “hands-off” in our operations, including recommending or requiring purchases or the use of a pharmaceutical donor’s drugs.
That is why it was so surprising that an insurance payer would deny our payments on behalf of a patient by saying we were inducing patients to use high-priced drugs or seek more expensive treatments. There were many productive conversations held, specifically with some insurance providers who were unaware of the regulatory framework under which nonprofit patient assistance organizations like Accessia Health operate. Once they understood the regulatory safeguards in place, payers agreed that non-profit organizations can lawfully provide health insurance premiums and cost-sharing in order to help patients receive the care they need.
Fast forward to today: Kentucky is the first state to embrace the nonprofit patient assistance model as a legitimate and compassionate way to provide financial assistance for people who can’t afford to pay for their health care. The bill as passed (which applies to health benefit plans issued or renewed on or after the effective date of the act, March 29, 2022) specifically recognizes patient assistance organizations that operate pursuant to an OIG Advisory Opinion as legitimate charitable resources, permitted to pay for health care needs of those who financially qualify. Kentucky insurers embraced the legislative opportunity to work with charitable patient assistance programs to address the high costs of medications for their insureds—shortly before America’s Health Insurance Plans (AHIP), the national association representing health insurance plans, echoed this sentiment.
In a recent legal filing, AHIP took the position that pharmaceutical companies should embrace working with bona fide charitable patient assistance organizations that have adopted regulatory safe harbors under specific OIG opinions. The document states, “The Anti-Kickback Statute does not, under the Department of Health and Human Services’ (HHS) interpretation, compel a finding of impermissible intent to induce purchases whenever someone pays for part of another’s medical care, even if that charitable support makes it possible for the patient to access federally funded health care services that they otherwise would not be able to access. Families, friends, and independent charities have no financial interest in the medical items a patient chooses to purchase and do not limit the patients’ choices to a product that they sell. That makes it highly unlikely that they possess the requisite ‘willful intent.’”
We agree with AHIP in that conclusion and will work with both payers and pharmaceutical manufacturers to ensure that qualifying patients are able to access the health care they need, thereby reducing additional long-term stresses on the health care system in the U.S.
Nearly 50% of U.S. patients with chronic conditions have been unable to afford out-of-pocket medical costs in the past year. We applaud Rep. Moser for championing the 2022 charge for patients in the commonwealth, as well as the Kentucky legislature and health insurance industry, as the passage of this important legislation is the first step in lowering this statistic.
In 2020, Accessia Health provided over $1.27 million in assistance to 447 Kentucky patients. Your support is crucial to helping us continue providing this critical financial lifeline.
Click here for more Op-Eds.
