Used to be that when a patient used cost-sharing assistance at the pharmacy counter, the amount counted towards a patient’s deductible and maximum out-of-pocket limit, thereby lowering the patient’s overall out-of-pocket spending.
The Trump administration Department of Health and Human Services last year finalized a new rule reversing that policy and allowing health insurers to omit certain prescription drug coupons from counting toward a patient’s deductible and out-of-pocket limit.
Donald McEachin (VA-04) and Rodney Davis (IL-13) are asking President Biden to reverse the copay accumulator policy change included in the 2021 Notice of Benefit and Payment Parameters.
“Millions of vulnerable Americans across the country rely on cost-sharing assistance to afford the medicines they need,” the letter stated. “Patients in the private health insurance market have increasingly relied on this assistance due to rising drug costs and health plan benefit design changes. Unfortunately, this assistance is increasingly being blocked from being applied to patient deductibles and out-of-pocket maximums.”
“During a global pandemic, we should be doing everything we can to increase affordability of prescription drugs, not decrease it, and reversing the 2021 NBPP copay accumulator policy will help people save more money at the pharmacy counter. We seek to ensure that all patients can access their needed medications,” the letter continues.
The Representatives’ letter is supported by the All Copays Count Coalition, including The AIDS Institute, Cancer Support Community, National Hemophilia Foundation and more than 60 other organizations.
“The health and economic challenges of COVID-19 have exposed social and health inequities in our system and reinforce the need to address affordability challenges for all patients,” said Leonard Valentino, MD, President and CEO at the National Hemophilia Foundation. “We thank Congressman McEachin, Congressman Davis, and the other members who joined them in requesting that President Biden improve access to treatment for people with inheritable blood disorders and many other patient communities affected by accumulator adjustor programs.”
Read the full letter here.
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