On January 27th, ASBM joined other patient advocacy organizations and physician groups in submitting a coalition letter to the U.S. Department of Health and Human Services (HHS), urging the Department to prohibit the practice of copay accumulator adjustment policies. The coalition letter was submitted as part of the comment period on the HHS Notice of Benefit and Payment Parameters for 2023 Proposed Rule (BPPR).
The letter was branded by the All Copays Count Coalition (ACCC), which is composed of groups serving the interests of people with chronic and serious health conditions that rely on copay assistance in various forms to make medically necessary drugs affordable.The comment letter was signed by 126 patient advocacy and physician organizations.
From the letter:
We are extremely disappointed that the proposed 2023 NBPP rule does not include any reference to copay accumulator adjustment policies, which financially benefit insurance issuers and pharmacy benefit managers while making crucial treatments unaffordable for patients. We strongly urge you to address this issue in the final rule by requiring that insurers and Pharmacy Benefit Managers (PBMs) count all copayments made by or on behalf of an enrollee toward the enrollee’s annual deductible and out-of-pocket limit.
The proposed NBPP for 2023 seeks to refine Section 156.125 of the Affordable Care Act (ACA), directly addressing the issue of discriminatory benefit design, intending to ensure that insurance plans do not discriminate against people living with chronic illness. While we support CMS’ intention to ensure that benefit design reflects clinical evidence rather than an effort to discriminate against people with high health care needs, we strongly urge CMS to also prohibit use of copay accumulator adjustment policies, which discriminate against people living with chronic illness.
Copay accumulator adjustment policies undermine ACA protections prohibiting insurers from charging people with pre-existing conditions more than healthier enrollees. Copay assistance is generally only available for specialty or medications without a medically equivalent generic, which are used by people with serious, complex chronic illness. These policies subvert the benefit of co-pay assistance, thereby discriminating against people living with chronic conditions.
Read the full letter here.
Read more about the Benefit and Payment Parameters for 2023 Proposed Rule here.