Tennesseans living with complex, chronic conditions know all too well that the systems designed to help them afford their medications are often quietly working against them. For years, many have been forced to navigate a maze of loopholes just to access treatments that allow them to work, care for their families and live productive lives.

I know this because at our infusion centers in East Tennessee and through our specialty pharmacy services across the state, we care for patients with serious autoimmune and neurologic conditions every day. We hear their stories and how they’re doing everything right by following their physician’s guidance, enrolling in copay assistance and committing to treatment plans that keep their conditions stable.

Copay assistance is a vital form of financial relief that helps patients afford their treatments, making it possible to stay on life-managing therapies. But increasingly, patients are being blindsided by insurance practices designed to circumvent the law and make it harder to access the medications they depend on.

In 2021, Tennessee lawmakers took an important step by banning copay accumulator programs, which forced patients to effectively pay for their medications twice. The intent was clear. Any assistance provided on behalf of patients should count toward their cost-sharing obligations.

Unfortunately, insurers have found new ways around that law.

Today, many plans use copay maximizers and alternative funding programs. These are presented as cost-saving tools, but in reality, they shift financial responsibility back onto patients in ways neither transparent nor predictable. Patients believe their assistance will count toward their deductible or out-of-pocket maximum, only to discover months later that it does not.

The consequences are deeply personal — disease progression, avoidable flare-ups, complications and irreversible clinical decline.

We have patients stable on infusion therapies, only to be told mid-year that their out-of-pocket costs had suddenly increased to thousands of dollars. Some delay or skip treatment while trying to understand their benefits or find additional support. Interruptions can lead to serious health setbacks.

These disruptions are not driven by medical necessity but instead by benefit design, and the problem is getting worse.

In recent years, we have seen a growing number of patients encounter these barriers, particularly those relying on high-cost specialty medications. Even short delays in treatment can carry serious clinical consequences. Meanwhile, care teams are spending more time navigating insurance hurdles instead of focusing on patient care.

Tennessee lawmakers have an urgent opportunity to fix this before the legislative session comes to a close. Senate Bill 420 offers a simple, commonsense solution by requiring that all copay assistance counts toward a patient’s cost-sharing obligations and prevents plans from diverting that support away from patients. It also stops the creation of new schemes designed to do just that.

States like Indiana, Maryland and New Jersey have already acted to close these loopholes.

There are efforts underway to weaken this bill through amendments that would expand exceptions, particularly for biologics and biosimilars, often the most expensive and medically necessary treatments. Such changes would leave vulnerable patients with fewer protections and create more barriers to care.

This issue is not about insurance mechanics. It is about people and their families. It is about whether patients can start treatment on time, stay on therapy and avoid being forced to choose between their health and their financial stability. If a patient has access to financial assistance and a prescribed therapy, nothing should stand in the way of receiving that care consistently and affordably.

I strongly support SB 420 and urge lawmakers to pass it in its original form. Every dollar intended to help a patient should count toward their deductible and out-of-pocket costs.

Patients, providers and families across Tennessee are calling on the Tennessee legislature to stop the behind-the-scenes insurance schemes once and for all.

Ryan Hollingsworth is the chief operating officer for FountainRx, BrookWell Infusion and Blue Ridge Neurology.