WASHINGTON, D.C. – Reps. Earl L. “Buddy” Carter (R-GA), Nanette Diaz Barragán (D-CA), and Mariannette Miller-Meeks (R-IA) today led a letter to Department of Health and Human Services (HHS) Secretary Xavier Becerra, Department of the Treasury Secretary Janet Yellen, and Department of Labor Acting Secretary Julie Su urging them to protect patients’ access to life-saving medications by affirming the 2020 Notice of Benefit and Payment Parameters (NBPP) Final Rule requiring that copay assistance count towards a patient’s deductible and annual limitation on cost-sharing in most instances.
This letter comes after HHS filed a notice of appeal of the U.S. District Court for the District of Columbia’s decision vacating the provision of the 2021 NBPP Final Rule that allows for health insurers and plans to pocket copay assistance without applying the dollars to a patient’s deductible or out-of-pocket maximum.
In the letter, the Members write: “We believe it would be beneficial to our constituents if a notice was quickly issued reaffirming the 2020 NBPP final rule that group health plans and health insurance issuers must count copay assistance toward the patient’s [maximum annual limitation on cost sharing (MOOP)] for drugs that do not have a medically appropriate generic equivalent available.”
The Members continue: “We believe [copay accumulator adjustment programs (AAPs)] permit health plans, PBMs, or third parties to profit from copay assistance, undermine the intended impact of this type of assistance, which helps eligible patients afford their out-of-pocket costs at the pharmacy counter and can significantly improve patient adherence to medicines.”
A 2021 study, cited in the letter, found that six in ten respondents “would have extreme difficulty affording their treatments without copay assistance programs being applied to their cost sharing.” Additionally, an IQVIA study found that “between 25-36% of respondents discontinued therapy when they received an unexpected charge of over $1,500 during the plan year as a result of AAPs,” which can result in life-threatening health consequences.
The letter, signed by 48 total members, is led by sponsors of the Help Ensure Lower Patient (HELP) Copays Act, which would ensure that patient’s copay assistance counts towards their deductible and out-of-pocket maximum. To date, 19 states, Puerto Rico, and Washington, D.C. have taken steps to ban or limit use of AAPs; however, a federal prohibition is necessary to assist all commercially insured patients.
Read the full letter here.
Learn more about the HELP Copays Act here.
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