Reform is needed to protect patients

Across Iowa and the nation, patients are struggling to afford medications they need to manage chronic and complex conditions. This struggle isn’t just about high drug prices— it’s about the ever-growing influence of pharmacy benefit managers (PBMs) and insurance companies that manipulate cost-sharing rules, making it harder for patients to access vital treatments.

Fortunately, Iowa lawmakers have the opportunity to change this by passing HF 852/ SF 383, companion bills that will ensure that all payments made toward prescription costs— including those made through copay assistance — count toward a patient’s out-of-pocket maximum.

As a rheumatologist, I saw firsthand how these policies affected my patients. Many battle painful autoimmune diseases requiring expensive specialty medications. For some, copay assistance is the only way they can afford these treatments.

Yet, insurers and PBMs have implemented a deceptive practice known as copay accumulator programs. These programs allow insurers to accept copay assistance payments, but then refuse to count them toward a patient’s deductible or out-of-pocket limit. Patients, thinking they are making progress toward their financial obligations, suddenly face unexpected bills amounting to thousands of dollars.

Patients who can’t afford their medications may be forced to switch to less effective treatments, suffer worsening symptoms, or abandon treatment altogether. This isn’t just bad for individual health outcomes — it also increases costs for the broader healthcare system. When patients can’t properly manage their conditions, they end up requiring more doctor visits, emergency care, and even hospitalizations. This is the reality copay accumulator programs create, and it’s why reform is needed.

HF 852 and SF 383 provide a straightforward, patient-centered solution: all payments made toward a medication—whether from the patient or through copay assistance—count toward their out-of-pocket maximum. This reform aligns Iowa with 21 other states that have already taken action to protect their residents from the harm caused by copay accumulator programs. It is a common-sense measure that will safeguard patient access to necessary treatments while restoring fairness and transparency to the insurance system.

It is important to recognize that HF 852 and SF383 do not interfere with free-market principles. Instead, they address an unfair loophole that PBMs and insurers exploit to shift more costs onto patients. By closing this loophole, the bill ensures that patients receive the financial support they were promised and that insurers uphold the integrity of cost-sharing agreements.

I strongly support this legislation and urge Iowa lawmakers to prioritize patient health over corporate profits. Passing a bill will reinforce Iowa’s commitment to patient-centered care, protect individuals with chronic illnesses, and prevent surprise medical expenses that undermine financial stability.

Iowa has the chance to stand up for its citizens by ensuring fair, transparent, and patient-focused healthcare policies.

Dr. Michael Brooks, MD, is a retired rheumatologist from Cedar Rapids.