Congressman A. Donald McEachin (D-VA-04) and Congressman Rodney Davis (R-IL-13) introduced the Help Ensure Lower Patient Copays Act to protect patients from increased out-of-pocket prescription drug costs.
The bipartisan bill builds on previous efforts to lower out-of-pocket costs for patients by prohibiting the use of copay accumulator programs, ensuring insurers cannot exclude the value of pharmaceutical manufacturer cost-sharing assistance from counting toward an enrollee’s annual cost-sharing limit.
“Access to life-saving prescription drug medications should not be complicated by undue financial barriers,” McEachin said. “As Americans continue navigating the coronavirus pandemic, we must take steps to protect them from undue out-of-pocket expenses. I am proud to introduce this bipartisan legislation, alongside Congressman Davis, to protect patients who rely on copay assistance.”
“Making prescription drugs more affordable for everyone is one of my top priorities and a bipartisan goal shared by Congress,” Davis said. “Especially with the costs of goods and services on the rise, patients shouldn’t have to face complicated financial barriers when purchasing prescription drugs. Every dollar saved counts. That’s why I’m proud to join Congressman McEachin in introducing this bipartisan legislation so we can provide financial relief to patients and promote their health at the same time.”
Historically, when a patient has utilized cost-sharing assistance at the pharmacy counter, the amount has counted towards a patient’s deductible and maximum out-of-pocket limit, thereby lowering patient’s overall out-of-pocket spending.
In June 2020, former Trump administration HHS Secretary Alex M. Azar, II finalized the 2021 NBPP rule, reversing that policy and allowing health insurers to adopt “copay accumulator adjustment programs.” These programs permit issuers to exclude cost-sharing assistance towards a patient’s OOP maximum, making it difficult for patients to afford their medicines. Moreover, allowing copay accumulator programs also impedes patient access to treatment amid an unprecedented pandemic and economic crisis.
“The National Hemophilia Foundation thanks Congressman McEachin and Congressman Davis for introducing the HELP Copays Act,” said Dr. Leonard A. Valentino, President/CEO, the National Hemophilia Foundation. “This critical bipartisan legislation will prevent health plans from implementing programs that are creating significant treatment access barriers. Considering the ongoing challenges that COVID-19 poses for many, this is an especially positive step in protecting patients with any sort of pre-existing, complex, or chronic health conditions.”
“Patients with HIV, hepatitis, and other chronic illness are struggling to afford their medicines as health care costs continue to rise. The bipartisan legislation introduced by Representatives McEachin and Davis will provide relief to many individuals who are facing the tough choice of paying for necessities like rent and groceries and filling a prescription for a life-saving medication,” said Rachel Klein, Deputy Executive Director, The AIDS Institute. “We urge Congress to take swift action to protect patients, ensuring that patients living with serious, complex chronic illness can get the health care they need.”
“Copay accumulator programs from insurance companies disproportionately affect those who are the sickest among us. Ensuring that copay assistance is counted toward the deductible and out-of-pocket maximum will ensure that patients receive financial relief immediately, and protecting essential health benefits ensures that individuals living with autoimmune disease and other chronic diseases aren’t treated differently just because they live with a chronic disease,” said Molly Murray, President & CEO, Autoimmune Association. “On behalf of the millions of patients living with autoimmune disease, we applaud this bipartisan bill that addresses out-of-pocket costs and protects essential health benefits for patients during a time that financial security and health is paramount.”
Reps. McEachin and Davis have continuously advocated for patients and have been outspoken critics of copay accumulator programs. Earlier this year, they sent a letter to President Joe Biden urging him to reverse the copay accumulator policy change included in the 2021 NBPP.
Last Congress, Reps. McEachin, Davis, and Wattson Coleman introduced the Preserving Patient Savings on Drug Costs Act to take immediate action on the NBPP rule during the COVID-19 pandemic.
Read the Help Ensure Lower Patient (HELP) Copays Act bill text and fact sheet.
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