WASHINGTON, D.C.— December 31, 2021 — In response to additional rulemaking for the Centers for Medicare & Medicaid Services’ (CMS) Notice of Benefit and Payment Parameters (NBPP) for 2023, the All Copays Count Coalition, which comprises more than 60 groups representing patients with serious and chronic health conditions, today released the following statement:
“While we are grateful for the Biden-Harris Administration’s efforts to increase access to health care, we are very disappointed that the draft NBPP does not include a provision that would clamp down on insurance issuer use of copay accumulator adjustment policies or close the essential health benefits loophole. These practices disproportionately target the most financially vulnerable patients with serious and chronic health conditions, creating an unfair cost burden and undermining pre-existing condition protections. We strongly urge CMS to address these policies when it issues a final rule.
“The All Copays Count Coalition appreciates the bipartisan support of policies that remove barriers to medications for vulnerable patients, including the recently introduced Help Ensure Lower Patient (HELP) Copays Act (H.R. 5801), and looks forward to further partnering with stakeholder groups, federal agencies, and lawmakers on commonsense approaches that eliminate barriers to necessary and lifesaving care.”
About the issue:
Millions of patients who depend on financial assistance to afford their medications are faced with huge bills in order to get the medications they need, even when they have insurance.
- Health plan policies called copay accumulator adjustments no longer count financial assistance toward the patient’s annual deductibles or their out-of-pocket maximum.
- In addition, a loophole in the Affordable Care Act allows many employer-sponsored health plans to deem certain critical and life-saving prescription drugs as “non-essential,” which significantly increases out-of-pocket costs for patients.
These practices hurt patient access to medicines, decrease drug adherence, and even cost our health care system more money.
About the All Copays Count Coalition
The All Copays Count Coalition (ACCC) includes the AIDS Institute, the Arthritis Foundation, the Cancer Support Community, the National Hemophilia Foundation, the National Multiple Sclerosis Society, the Immune Deficiency Foundation, and more than 60 other groups serving the interests of patients with chronic and serious health conditions that rely on copay assistance in various forms to make medically necessary drug treatments affordable.
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