1
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are not prepared with that
kind of money, and you

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aren't going to get your
medication.

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>> There has been some
movement in the state's

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legislature to address
things like copay

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accumulators, open
formularies and pharmacy

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access. We're joined by
someone on the front lines

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of this work. Rob Gunderman,
president and CEO of the

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Coalition of Wisconsin
Aging and Health Groups.

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And thanks for being here.
>> Thanks for having me.

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>> So tell me a little bit
about how you got started

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in all of this.
>> Sure. Well, I started

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getting calls from patients
who were trying to get

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their medications. They'd
go to the pharmacy counter,

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and they were being told
that it would be thousands

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of dollars to get the
medication that they're

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used to paying 30, 40, $50,
whatever their copay was.

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And they were learning that
a copay accumulator had

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been applied to their
policy. The one that really

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struck me was a woman with
a heart condition who

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needed this heart
medication to live, and she

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went up like she always
does to buy her medication.

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They said it was gonna be
$3,800. They didn't have

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$3,800. And her husband had
to go to the bank and take

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out a loan so she could get
the medication she needs to

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live. And I realized, we
have a problem here. And

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that woman who I've come to
know, she her family is

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going into debt more and
more every year having to

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deal with this. So that's
how I got involved in this.

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>> And as you've been
working on these issues, is

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this just all too common?
>> You know, when I started

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out in this, it wasn't that
common. It was I was seeing

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in a plan here and people
were starting to come to me.

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Now it's become very common.
It's spreading like

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wildfire. There are very
few plans left. I don't

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even know of a plan left in
Wisconsin that doesn't have

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a copay accumulator other
than the group, the state

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insurance plan.
>> And there's accumulators,

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maximizers and those sound
like good things.

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>> They do. They use catchy
terminology, and they've

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probably run this through
marketing groups to see

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what what people like and
what people don't like. But

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you're exactly right. There
are copay accumulators,

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they're copay maximizers.
They're all doing

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essentially the same thing,
but just from a little bit

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different angle. You know,
when you look at this copay,

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accumulator piece, it just
to me, this is just so

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unfair and I don't it's
been difficult for me to

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understand how this has
been allowed. If you and I

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went out to dinner and I
paid for your your dinner

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and the restaurant said,
we've adopted a copay

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policy where you have to
pay for your your meal and

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you say, well, Rob already
paid for my meal. Yes. And

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we appreciate that. And
we're going to keep his

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money. But you also have to
pay for your meal. You say,

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this isn't fair. You're
getting paid twice for the

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meal. This is what the
insurance companies are

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fine.
you've seen on patients?

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What does this do to
someone who's making this

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impossible decision?
>> Well, a couple of things.

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One, the financial stress
that it's putting families

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under that just can't
afford this. But the other

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piece is I've had people
tell me they're not going

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to take their medication
anymore. I had a friend of

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mine who has Ms. And he
says if they put one of

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these copay accumulators on
my policy, I'm going to

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stop taking my medication.
So you then end up with

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more problems with their
health. And I don't think

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that's a cost saving
measure by, you know,

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taking this money, they may
get some money out of it.

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But I think in the long run,
the increased health

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expenses that you're going
to have for people if they

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stop taking their
medications are going to

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offset that.
we've seen in these stories,

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people don't know until
they're so far along that

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they owe all this extra
money. There's no ability

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to have a payment plan for
your medications. So you

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either get it or you don't.
How difficult is it for

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people to even know that
something like this is on

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their plan? How much of it
is just poor communication?

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>> That's a lot of it. It's
very difficult. I've looked

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at some of these plans, 50,
60 pages, and who's going

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to read 50 or 60 pages of
fine print? Some of this is

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a very small it's hard to
read, especially if your

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00:03:51,565 --> 00:03:53,667
eyes aren't so good as mine
aren't anymore. It's hard

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to spot this little clause
in there that says, and

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even if you read it, if you
don't know already what a

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copay accumulator is,
you're not going to

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00:04:01,808 --> 00:04:04,011
understand what they're
saying in there.

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00:04:04,077 --> 00:04:06,547
>> Now, Senate President
Mary Felzkowski has been

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00:04:06,613 --> 00:04:11,051
working on legislation like
this for many years, many

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00:04:11,118 --> 00:04:14,087
sessions. What are the
concerns that state

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00:04:14,154 --> 00:04:16,924
lawmakers have had making
it so difficult to move

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00:04:16,990 --> 00:04:19,893
this forward?
>> So I think the the one

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thing that's really held us
up with state law, well, a

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00:04:23,030 --> 00:04:25,065
couple of arguments that
the insurers have made. One

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is that this will drive
patients to more expensive

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00:04:27,835 --> 00:04:31,538
brand name medications. We
know 98% of the medications

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00:04:31,605 --> 00:04:33,874
in this group, these
expensive medications there

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00:04:33,941 --> 00:04:37,544
isn't a generic for. But
Senator Felzkowski put in

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00:04:37,611 --> 00:04:40,147
language in the bill saying
that this only applies to

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medications for which there
is not a generic equivalent.

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So that's off the table.
There's still making that

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argument, though. The other
argument that we're hearing

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is that it will drive up
insurance premiums. But

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there's studies that have
been done looking at states

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that have already passed
this type of legislation

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where the premiums haven't
increased. And conversely,

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studies have looked at
states that haven't passed

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00:05:01,134 --> 00:05:03,337
this legislation and
premiums aren't lower there,

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like in Wisconsin, our
premiums aren't lower where

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we don't have that.
>> Where does it currently

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00:05:07,508 --> 00:05:11,111
stand? And what, if
anything, has changed

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throughout this session as
it's gone through committee?

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>> Sure. Well, we had a
committee hearing, which

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00:05:15,549 --> 00:05:17,684
was the first. This is the
second session that we've

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00:05:17,751 --> 00:05:21,355
tried to run this bill, and
we weren't able to get a

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00:05:21,421 --> 00:05:23,390
vote out of committee last
session. This session,

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00:05:23,457 --> 00:05:26,293
we've got a 5 to 0 vote. So
the entire committee voted

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00:05:26,360 --> 00:05:29,363
in favor of passing this
out in the Senate. And we

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00:05:29,429 --> 00:05:32,332
expect that to come up to
the onto the floor at some

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00:05:32,399 --> 00:05:34,968
point in January. We just
don't know when. And so,

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you know, there's a
definite shift here where

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00:05:37,838 --> 00:05:41,508
the momentum has shifted. I
think there are 40

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co-sponsors on the bill.
But I think I think the

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00:05:43,844 --> 00:05:46,380
votes are there to pass the
bill. If we can get the

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00:05:46,446 --> 00:05:49,583
votes.
next story, that he didn't

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00:05:50,918 --> 00:05:53,420
know that the formulary had
changed. And that's

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00:05:53,487 --> 00:05:56,256
something that's been a
point of contention in the

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00:05:56,323 --> 00:05:58,325
legislation. Has that
changed as it's gone

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00:05:58,392 --> 00:06:00,794
through committee?
>> Yeah. So the insurers

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wanted to be able to change
the formulary throughout

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00:06:03,397 --> 00:06:06,967
the year. And right now
they could only change it

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00:06:07,034 --> 00:06:08,902
during the window and
people can change plans.

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And I said we didn't have a
problem with that. As long

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00:06:11,972 --> 00:06:14,675
as they weren't able to
force the patient to change

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00:06:14,741 --> 00:06:17,344
their medication mid-year.
So I think it's actually a

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00:06:17,411 --> 00:06:19,546
benefit to patients,
because if you're going to

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00:06:19,613 --> 00:06:23,450
to make a formulary change,
tell them in June or July,

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00:06:23,517 --> 00:06:26,286
give them as much time as
possible to figure out what

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00:06:26,353 --> 00:06:28,822
they're going to do and
find a new plan that will

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00:06:28,889 --> 00:06:31,058
cover whatever the
medication is that they're

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00:06:31,124 --> 00:06:32,993
taking that is going to be
leaving your formulary. So

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00:06:33,060 --> 00:06:35,796
I think I don't see a
downside to that.

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00:06:35,863 --> 00:06:38,398
>> Overall, premiums are
going up. If people feel

145
00:06:38,465 --> 00:06:41,635
like they're not properly
covered under a plan that

146
00:06:41,702 --> 00:06:44,371
they're paying a lot of
money for every month, do

147
00:06:44,438 --> 00:06:47,274
you think patients will
just end up foregoing a

148
00:06:47,341 --> 00:06:50,277
health plan altogether?
>> That's our that's our

149
00:06:50,344 --> 00:06:53,080
concern, our worry. I think
there are people who

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00:06:53,146 --> 00:06:55,249
they're going to look at
this and say, I'm paying so

151
00:06:55,315 --> 00:06:58,118
much out of pocket anyway.
I'm not ever using the

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00:06:58,185 --> 00:07:00,087
insurance, so what's the
point of having it? And

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00:07:00,153 --> 00:07:02,456
then when they have
something serious happen,

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00:07:02,523 --> 00:07:05,726
then it's more problems.
And it's not like someone

155
00:07:05,792 --> 00:07:08,929
isn't paying for that.
>> Now we just saw Congress

156
00:07:08,996 --> 00:07:11,999
go through the longest
government shutdown in

157
00:07:12,065 --> 00:07:16,870
history over these enhanced
tax credits, and we're

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00:07:17,804 --> 00:07:21,708
still seeing premiums go up
all around. How much of

159
00:07:21,775 --> 00:07:25,112
this is kind of reaching a
turning point as healthcare

160
00:07:25,179 --> 00:07:27,881
premiums, costs are all
going up and there doesn't

161
00:07:27,948 --> 00:07:31,318
seem to be an end in sight.
>> We're getting to the

162
00:07:31,385 --> 00:07:33,420
point where something has
to happen and we can't. My

163
00:07:33,487 --> 00:07:36,290
insurance went up almost
25% this year. We can't

164
00:07:36,356 --> 00:07:40,127
have 25% annual increases
in our health costs, just

165
00:07:40,194 --> 00:07:42,829
as Americans. We can't
afford it. So we have to

166
00:07:42,896 --> 00:07:45,165
figure something out. And I
don't know what that answer

167
00:07:45,232 --> 00:07:47,868
is. I mean, people, smarter
people than me, have been

168
00:07:47,935 --> 00:07:50,704
trying to figure this out
for a very long time. But

169
00:07:50,771 --> 00:07:53,106
we're getting to the point
where we have to. This

170
00:07:53,173 --> 00:07:55,909
isn't an option anymore. We
can't afford to keep going

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00:07:55,976 --> 00:07:58,645
the way that we're going.
And for a lot of families

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00:07:58,712 --> 00:08:02,616
without the the Affordable
Care Act plans being

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00:08:02,683 --> 00:08:07,588
available to them, I think
available to them, I think