Government Relations Update – May 2024


Copay Accumulator Adjusters: The HELP Copays Act (HR 830 and S. 1375) has seventeen cosponsors in the Senate and 134 House cosponsors, an increase of 23 cosponsors since NBDF’s Washington Days.  


California: AB 2180, the state’s copay accumulator adjuster bill, was held on the Assembly Appropriations Committee suspension calendar, effectively ending any hopes for passage this session.  All bills must pass the chamber of origin by June 1 to remain active.  

Colorado: NBDF, The Hemophilia Alliance, and the Hemophilia and Thrombosis Center at the Anschutz Medical Center met with the Colorado Medicaid Pharmacy program leadership May 15 to discuss Medicaid pharmacy reimbursement, 340B, and gene therapy.

Michigan: The Hemophilia Foundation of Michigan is urging members of the Michigan House Insurance Committee to schedule a hearing on HB 4357, the state’s copay accumulator legislation, and HB 5339, legislation to provide guardrails to step therapy.  

Missouri: Unfortunately, SB 921 was unable to make it out of the senate because they filibustered. The bill will be refiled next session.

Nevada: The state Division of Insurance announced that it will begin enforcing the ban on copay accumulator adjuster policies included in the federal 2020 Notice of Benefit and Payment Parameters for state regulated health insurance plans issued in 2025. The requirement of insurers is included in the DOI’s 2025 Health Benefit Plan Filing Guidance. The guidance also closes the “Essential Health Benefits loophole” that allows insurers to implement copay maximizer programs which drain the entirety of a patient’s annual copay assistance but does not apply that money to the patient’s cost sharing obligation.

New Hampshire: SB 354, New Hampshire’s copay accumulator adjuster legislation, was amended by the House Committee on Commerce and Consumer Affairs. The amendment, which NBDF does not support, carves out high deductible health plans and has several provisions antithetical to the effort.  

On June 5th SB 354 went to conference and the house and senate could not come to a compromise. The bill will be refiled next session.  

North Dakota: On June 17 the joint legislative Employee Benefits Review Committee will meet to consider the actuarial analyses for over a dozen health care-related bills that were submitted to the committee for review on April 1 including bills dealing with copay accumulator adjuster policies (Rep. Karls) and step therapy reform (Sen. Barta).

Oregon:  On May 30, Gov. Kotek signed HB 4113, the state’s copay accumulator adjuster bill, into law.  Oregon becomes the 20th state to restrict the use of CAAPs.

Pacific Northwest Bleeding Disorders and NBDF met with the leadership of the state Prescription Drug Affordability Board May 6 to discuss the Board’s process for patient engagement.

Pennsylvania: The Eastern and Western Pennsylvania Bleeding Disorders Foundation’s held their advocacy day in Harrisburg on May 7th. Advocates spoke to legislators about SB 372, the Commonwealth’s copay accumulator legislation, alongside expansion of the HTC line item in the State budget, and SB 1016, which would require Pennsylvania to apply for a waiver to allow for period products to be purchased with SNAP and WIC funds.  

Rhode Island: NBDF and the New England Hemophilia Association sent a letter to the Rhode Island Speaker of the House, K. Joseph Shekarchi, urging the House to vote on H 8041, which would ban copay accumulator adjusters in the state.  

Vermont: Two pieces of legislation supported by NBDF passed out of the Vermont Legislature in the final days of session. H 766, which provides guardrails for step therapy and streamlines prior authorization, was signed by Governor Scott on May 21st.

On May 30, Gov. Scott signed S. 233, making Vermont the 21st state to restrict the use of copay accumulator adjuster policies.

Other News:

Utah: Last week Fox13 television news in Salt Lake City ran a five-part investigative story on the use of copay accumulator adjuster policies and their impact on patients.

Patients with pricey meds experience insurance companies 'double dipping' ( 

Patients turn to rationing medications after insurance denies copay assistance (  

Utah lawmakers respond to patients paying thousands for lifesaving treatments (