WASHINGTON, D.C. - Reps. Earl L. “Buddy” Carter (R-GA), Nanette Barragán (D-CA), and Mariannette Miller-Meeks (R-IA) today celebrated the Biden administration’s decision to drop its appeal in a case against the patient community, keeping in effect the District of Columbia’s District Court ruling 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 decision comes after Carter, Barragán, and Miller-Meeks, 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, led 48 Members in a December 2023 letter urging Department of Health and Human Services Secretary Xavier Becerra, Department of the Treasury Secretary Janet Yellen, and Department of Labor Acting Secretary Julie Su to protect patients’ access to life-saving medications.
“Co-pay accumulator schemes allow insurers and PBMs to steal the assistance some patients rely on to access their life-saving medications. This is wrong and must end. I applaud the Biden administration for standing with patients by dropping its appeal and will continue working to ensure that this final rule is enforced. I look forward to working with my bipartisan colleagues to pass the HELP Copays Act, so that we can move closer to a health care system that puts patients before profits,” said Rep. Buddy Carter.
"About one in five adults say that they have not filled a prescription because they couldn’t afford to, and this experience is more likely among low-income communities like many that I represent. It is unacceptable that the high cost of prescription drugs leads people to ration or not purchase the medication they need. That's why I joined my colleagues to send a letter to HHS that urges the federal agencies to drop the appeal and count copay assistance towards patients’ deductible and out of pocket maximum. I commend HHS for withdrawing its appeal and taking a step towards ensuring patients are able to afford their lifesaving medications. I continue to recommend that HHS quickly adopt policies from the 2020 NBPP final rule that will count copay assistance towards patients’ deductible and annual limitation on cost-sharing,” said Rep. Barragán.
“I am encouraged that the Administration decided to drop their appeal and ensure that co-pays are going toward the cost of medications instead of lining the pockets of the PBM conglomerates,” said Miller-Meeks. “While the dismissal of the appeal is certainly a significant demonstration of support of patients, there is still much work that needs to be done to address harmful insurance and PBM practices. I look forward to continuing to work with Rep. Carter and Rep. Barragán on the ‘HELP Co-Pays Act,’ which protects patients and ensures their co-pays are going toward the cost of their medications.”
A 2021 study, cited in the Member’s December 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.
To date, 19 states, Puerto Rico, and Washington, D.C. have taken steps to ban or limit use of AAPs; however, a federal prohibition, such as proper enforcement of the 2020 Notice of Benefit and Payment Parameters (NBPP) Final Rule, 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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